Basic Information
| Provider Information | |||||||||
| NPI: | 1104322692 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | APENA | ||||||||
| FirstName: | KAOSARAT | ||||||||
| MiddleName: | OLAMIDE OYINKANSOLA | ||||||||
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| Credential: | LGSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14900 MEANDERWOOD LN | ||||||||
| Address2: | |||||||||
| City: | BURTONSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208662217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013571169 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9701 PHILADELPHIA CT STE R | ||||||||
| Address2: | |||||||||
| City: | LANHAM | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207064435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434386742 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2018 | ||||||||
| LastUpdateDate: | 04/03/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 22358 | MD | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.