Provider Demographics
NPI:1063259919
Name:SHAHZAD, AISHA YAQOOB (MS, LMHC-A)
Entity type:Individual
Prefix:MISS
First Name:AISHA
Middle Name:YAQOOB
Last Name:SHAHZAD
Suffix:
Gender:F
Credentials:MS, LMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-3305
Mailing Address - Country:US
Mailing Address - Phone:401-231-1937
Mailing Address - Fax:
Practice Address - Street 1:105 BACON ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-5542
Practice Address - Country:US
Practice Address - Phone:401-230-4615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00210-A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health