Omolara Ajibola, LICSW
Individual provider Active NPI Clinical Social Worker · Washington, DC
NPI 1710487293 · NPPES record last updated Feb 20, 2018
Key facts
- NPI
- 1710487293
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- LC50081174 (DC)
- Practice address
- 200 I St SE
Washington, DC 20003-3317 - Phone
- (202) 717-0062
- NPI assigned
- Feb 20, 2018
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2013
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
66 E Flagler St
Miami, FL 33130-1807
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX, DC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210923001782 | TX | Practitioner - Clinical Social Worker | 9234536871 | Reassigns benefits to 1 organization |
| I20251115000405 | DC | Practitioner - Clinical Social Worker | 9234536871 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LC50081174 | DC | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grow Healthcare Group PA | Clinical | Current |
Accepting new patients |
Locations
66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711
700 Milam St
Ste 1300
Houston, TX 77002
Phone (281) 801-8391
8300 Boone Blvd
Ste 500
Vienna, VA 22182
Phone (703) 884-2598
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LC50081174 | DC | Yes |
Addresses
Primary practice location
200 I St SE
Washington, DC 20003-3317
Mailing address
2700 Melisa Dr
Fort Washington, MD 20744-2582
Phone (401) 954-3493
Other providers in Washington, DC
- Olayinka Adeola Ajewole
- Kehinde Adegbenga Ajibade
- Abisola Ajibike
- Beatrice Mopelola Ajibise
- Abayomi Tomori Ajibola
- Omotunde O Ajibola
- Nusirat Ajiboye
- Olanrewaju Ajibola Ajiboye
- Peter Ajiboye
- Maria Ajifo
All providers in Washington, DC · Clinical Social Worker in District of Columbia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 20, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.