Healthcare Provider Details

I. General information

NPI: 1881116861
Provider Name (Legal Business Name): SABAH MOURAD MHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 07/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3708 91ST ST STE 3A
JACKSON HEIGHTS NY
11372-7962
US

IV. Provider business mailing address

2408 23RD ST
ASTORIA NY
11102-2836
US

V. Phone/Fax

Practice location:
  • Phone: 718-779-2263
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: