Provider Demographics
NPI:1871900845
Name:OKUNDAYE, OMORUYI EPHRAIM (MSW, LCSW-C, LCADC)
Entity type:Individual
Prefix:
First Name:OMORUYI
Middle Name:EPHRAIM
Last Name:OKUNDAYE
Suffix:
Gender:M
Credentials:MSW, LCSW-C, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7921
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221-0921
Mailing Address - Country:US
Mailing Address - Phone:443-682-5807
Mailing Address - Fax:
Practice Address - Street 1:16 W 25TH ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5002
Practice Address - Country:US
Practice Address - Phone:443-682-5807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA369101YA0400X
MDLC17618101YM0800X
MD101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral