Provider Demographics
NPI:1154980662
Name:HUSSEIN, MUTAJAH (DSW, LISW, JD)
Entity type:Individual
Prefix:
First Name:MUTAJAH
Middle Name:
Last Name:HUSSEIN
Suffix:
Gender:F
Credentials:DSW, LISW, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13700 FAIRHILL RD APT 306
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-1258
Mailing Address - Country:US
Mailing Address - Phone:216-408-9355
Mailing Address - Fax:
Practice Address - Street 1:13700 FAIRHILL RD APT 306
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44120-1258
Practice Address - Country:US
Practice Address - Phone:216-408-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-08
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
OHI.21028511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker