Provider Demographics
NPI:1366120966
Name:HASSAN, MAHAD HUSSEIN I
Entity type:Individual
Prefix:
First Name:MAHAD
Middle Name:HUSSEIN
Last Name:HASSAN
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1826 QUARRY OAKS DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-5700
Mailing Address - Country:US
Mailing Address - Phone:859-803-8429
Mailing Address - Fax:
Practice Address - Street 1:1826 QUARRY OAKS DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-5700
Practice Address - Country:US
Practice Address - Phone:859-803-8429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Single Specialty