Provider Demographics
NPI:1902234008
Name:OGUNSEMORE, LATIFATU KIKELOMO
Entity Type:Individual
Prefix:
First Name:LATIFATU
Middle Name:KIKELOMO
Last Name:OGUNSEMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 ENID ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-2314
Mailing Address - Country:US
Mailing Address - Phone:508-615-6790
Mailing Address - Fax:
Practice Address - Street 1:10 ENID ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-2314
Practice Address - Country:US
Practice Address - Phone:508-615-6790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health