1285130054 NPI number — KUDIRAT A ONITIRI ED.S, LCADC, LMFT

Table of content: KUDIRAT A ONITIRI ED.S, LCADC, LMFT (NPI 1285130054)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285130054 NPI number — KUDIRAT A ONITIRI ED.S, LCADC, LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ONITIRI
Provider First Name:
KUDIRAT
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ED.S, LCADC, LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ONITIRI
Provider Other First Name:
KATIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ED.S, LCADC, LMFT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1285130054
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2052 LIBERTY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRENTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08629-2210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-508-3865
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
TCNJ CCC FORCINA HALL
Provider Second Line Business Practice Location Address:
2000 PENNINGTON RD. SUITE 413
Provider Business Practice Location Address City Name:
EWING
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-429-0867
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/02/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  37LC00239100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: 37FI001972 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)