Provider Demographics
NPI:1528637824
Name:FARRAKHAN, SAFIYAH (LICSW)
Entity type:Individual
Prefix:MS
First Name:SAFIYAH
Middle Name:
Last Name:FARRAKHAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 55TH ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-6565
Mailing Address - Country:US
Mailing Address - Phone:202-491-8631
Mailing Address - Fax:
Practice Address - Street 1:81 55TH ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-6565
Practice Address - Country:US
Practice Address - Phone:202-491-8631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500820311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical