Provider Demographics
NPI:1053500249
Name:MOMOH, FEYISAYO M (LCSW)
Entity type:Individual
Prefix:MRS
First Name:FEYISAYO
Middle Name:M
Last Name:MOMOH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:FEYISAYO
Other - Middle Name:M
Other - Last Name:IROKO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:25590 PROSPECT AVE APT 9A
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3144
Mailing Address - Country:US
Mailing Address - Phone:408-594-5008
Mailing Address - Fax:
Practice Address - Street 1:9310 SIERRA AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-5711
Practice Address - Country:US
Practice Address - Phone:408-594-5008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker