Provider Demographics
NPI:1124732979
Name:AHSAN, HAFSA
Entity type:Individual
Prefix:
First Name:HAFSA
Middle Name:
Last Name:AHSAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3245 GROVE AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3475
Mailing Address - Country:US
Mailing Address - Phone:847-920-7551
Mailing Address - Fax:
Practice Address - Street 1:3245 GROVE AVE STE 107
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3475
Practice Address - Country:US
Practice Address - Phone:847-920-7551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker