Provider Demographics
NPI:1063608339
Name:ABDUR-RAHMAN, FAZEEDA (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:FAZEEDA
Middle Name:
Last Name:ABDUR-RAHMAN
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7580 184TH ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1715
Mailing Address - Country:US
Mailing Address - Phone:718-844-5390
Mailing Address - Fax:718-732-2656
Practice Address - Street 1:7580 184TH ST
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1715
Practice Address - Country:US
Practice Address - Phone:347-601-0249
Practice Address - Fax:718-732-2656
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC062019001041C0700X
NY087518-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical