Healthcare Provider Details

I. General information

NPI: 1962869735
Provider Name (Legal Business Name): ZAINAB ABDULAZIZ AL-KHABBAZ BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2016
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 TEN ROD RD STE 101
NORTH KINGSTOWN RI
02852-4161
US

IV. Provider business mailing address

166 LEDGEWOOD RD APT 409
GROTON CT
06340-6622
US

V. Phone/Fax

Practice location:
  • Phone: 401-294-3990
  • Fax:
Mailing address:
  • Phone: 608-335-7633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-15-19622
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: