Provider Demographics
NPI:1083203046
Name:OSAIGBOVO, OTASOWIE LILLIAN (LCSW)
Entity type:Individual
Prefix:MS
First Name:OTASOWIE
Middle Name:LILLIAN
Last Name:OSAIGBOVO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1178 BROADWAY FL 3
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-5666
Mailing Address - Country:US
Mailing Address - Phone:551-257-3810
Mailing Address - Fax:
Practice Address - Street 1:1178 BROADWAY FL 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5666
Practice Address - Country:US
Practice Address - Phone:551-257-3810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC064424001041C0700X
CT0148631041C0700X
NY0978701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical