MEDICARE: MR. RASOOL ABDULLAH LCADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1235589953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RASOOL ABDULLAH LCADC

Provider Business Mailing Address
First Line	:	300 S 12TH ST
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07103-1960
Country	:	US
Telephone Number	:	973-622-4934
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 S 12TH ST
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07103-1960
Country	:	US
Telephone Number	:	973-622-4934
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2016
Last Update Date	:	06/14/2016

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