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NPI Code Detail

MEDICARE: HAFSA LIBAN JAMA

MEDICARE: HAFSA LIBAN JAMA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1396593521
Entity Type Code : Individual
Provider Name (Legal Business Name) : HAFSA LIBAN JAMA
Provider Business Mailing Address
First Line : 6810 LYDIA LN
Second Line :
City : WOODBURY
State : MN
Zip : 55125-6707
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2812 FAIRVIEW AVE N
Second Line :
City : ROSEVILLE
State : MN
Zip : 55113-1308
Country : US
Telephone Number : 612-345-7306
Fax Number : 612-587-1103
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2024
Last Update Date : 05/13/2024

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Directions to “ HAFSA LIBAN JAMA ” Practice Location

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