Healthcare Provider Details

I. General information

NPI: 1154980662
Provider Name (Legal Business Name): MUTAJAH HUSSEIN DSW, LISW, JD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2019
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 ROCKSIDE RD STE 216
PARMA OH
44134-2749
US

IV. Provider business mailing address

13700 FAIRHILL RD APT 306
SHAKER HEIGHTS OH
44120-1258
US

V. Phone/Fax

Practice location:
  • Phone: 216-777-6062
  • Fax:
Mailing address:
  • Phone: 216-408-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2102851-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: