Provider Demographics
NPI:1063798668
Name:YUSUF, AHMED MOHAMED (LICSW)
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:MOHAMED
Last Name:YUSUF
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 E LAKE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1852
Mailing Address - Country:US
Mailing Address - Phone:612-296-6214
Mailing Address - Fax:612-216-5487
Practice Address - Street 1:1201 E LAKE ST STE 1
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1852
Practice Address - Country:US
Practice Address - Phone:612-296-6214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN212571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical