Provider Demographics
NPI:1689230666
Name:FADAHUNSI, OPEYEMI (LCSW)
Entity type:Individual
Prefix:
First Name:OPEYEMI
Middle Name:
Last Name:FADAHUNSI
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1159 E 104TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4527
Mailing Address - Country:US
Mailing Address - Phone:347-447-7813
Mailing Address - Fax:
Practice Address - Street 1:1159 E 104TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4527
Practice Address - Country:US
Practice Address - Phone:646-528-3109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-15
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1064961104100000X
0998271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker