Healthcare Provider Details

I. General information

NPI: 1366120966
Provider Name (Legal Business Name): MAHAD HUSSEIN HASSAN I
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1826 QUARRY OAKS DR
FLORENCE KY
41042-5700
US

IV. Provider business mailing address

1826 QUARRY OAKS DR
FLORENCE KY
41042-5700
US

V. Phone/Fax

Practice location:
  • Phone: 859-803-8429
  • Fax:
Mailing address:
  • Phone: 859-803-8429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: