Healthcare Provider Details

I. General information

NPI: 1427609015
Provider Name (Legal Business Name): ABDUL-RAHMAAN IBN MUHAMMAD LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 GILLETT ST
HARTFORD CT
06105-2630
US

IV. Provider business mailing address

111 GILLETT ST
HARTFORD CT
06105-2630
US

V. Phone/Fax

Practice location:
  • Phone: 860-656-0450
  • Fax: 860-656-0491
Mailing address:
  • Phone: 860-656-0450
  • Fax: 860-656-0491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number3024
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number3024
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3024
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: