Provider Demographics
NPI:1376251603
Name:BODUNDE, ADENIKE I (RBT)
Entity type:Individual
Prefix:
First Name:ADENIKE
Middle Name:
Last Name:BODUNDE
Suffix:I
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:ADENIKE
Other - Middle Name:
Other - Last Name:BODUNDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RBT
Mailing Address - Street 1:121 HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-4279
Mailing Address - Country:US
Mailing Address - Phone:862-384-6922
Mailing Address - Fax:973-704-9857
Practice Address - Street 1:121 HUDSON ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-4279
Practice Address - Country:US
Practice Address - Phone:862-384-6922
Practice Address - Fax:973-704-9857
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst