Provider Demographics
NPI:1023877941
Name:ADEDURO, ADEGBEMISOLA
Entity type:Individual
Prefix:
First Name:ADEGBEMISOLA
Middle Name:
Last Name:ADEDURO
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 1:4511 KNOX RD STE 201
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-3380
Mailing Address - Country:US
Mailing Address - Phone:240-582-7513
Mailing Address - Fax:301-979-7504
Practice Address - Street 1:4511 KNOX RD STE 201
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-3380
Practice Address - Country:US
Practice Address - Phone:240-582-7513
Practice Address - Fax:301-979-7504
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-14
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD336291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical