Provider Demographics
NPI:1174182042
Name:ORIMOLOYE, EBUNOLUWA TOLUWANI
Entity type:Individual
Prefix:
First Name:EBUNOLUWA
Middle Name:TOLUWANI
Last Name:ORIMOLOYE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EBUNOLUWA
Other - Middle Name:
Other - Last Name:ORIMOLOYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 RUGGLES ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-3652
Mailing Address - Country:US
Mailing Address - Phone:401-206-5698
Mailing Address - Fax:626-227-7862
Practice Address - Street 1:110 RUGGLES ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-3652
Practice Address - Country:US
Practice Address - Phone:401-206-5698
Practice Address - Fax:626-227-7862
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MALICSW1252111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110205357AMedicaid