Provider Demographics
NPI:1427609015
Name:MUHAMMAD, ABDUL-RAHMAAN IBN (LMSW)
Entity type:Individual
Prefix:
First Name:ABDUL-RAHMAAN
Middle Name:IBN
Last Name:MUHAMMAD
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 GILLETT ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-2630
Mailing Address - Country:US
Mailing Address - Phone:860-656-0450
Mailing Address - Fax:860-656-0491
Practice Address - Street 1:111 GILLETT ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-2630
Practice Address - Country:US
Practice Address - Phone:860-656-0450
Practice Address - Fax:860-656-0491
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3024104100000X, 1041S0200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1619204674Medicaid