Provider Demographics
NPI:1871102715
Name:ADEYEMO, HASSAN AYOBAMI
Entity type:Individual
Prefix:
First Name:HASSAN
Middle Name:AYOBAMI
Last Name:ADEYEMO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5041 F ST FL 2
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-3501
Mailing Address - Country:US
Mailing Address - Phone:215-758-5392
Mailing Address - Fax:
Practice Address - Street 1:5041 F ST FL 2
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-3501
Practice Address - Country:US
Practice Address - Phone:021-578-3754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH003737103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst