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Organization
MC QUEEN AND OTUYELU LCSW WELLNESS
Active
Organization
MC QUEEN AND OTUYELU LCSW WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FONUSHO O OTUYELU LCSW (CO-PARTNER)
(347) 410-2770
Entity
Organization
Contact information
Practice address
941 FOREST AVENUE, STATEN ISLAND, NY 10310
(347) 410-2770
(718) 273-4017
Mailing address
39 LOCKMAN AVENUE, STATEN ISLAND, NY 10303
(347) 410-2770
(718) 273-4017
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
07/25/2019
Last updated
07/25/2019
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