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General NPI Number Information
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NPI Number | 1154744001
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Entity Type | Individual
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Provider Name | KASIM ABDURRAZZAQ MSW LICSW
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Gender | Male
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Dates
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Enumeration Date | 01/29/2014
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Last Update Date | 08/12/2016
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Provider Practice Location Address
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Address Line | 1041 SELBY AVE
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City | SAINT PAUL
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State | MN
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Zip | 55104-6535
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Country | US
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Telephone | 612-813-5034
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Fax | 651-925-0044
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Provider Business Mailing Address
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Address Line | 1437 MARSHALL AVE SUITE 102
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City | SAINT PAUL
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State | MN
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Zip | 55104-6350
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Country | US
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Telephone | 651-329-6171
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Fax | 651-340-9266
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 19934
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License Number State | MN
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