Provider Demographics
NPI:1841522406
Name:ABDUSSAMAD, FATIMA (MSW)
Entity type:Individual
Prefix:
First Name:FATIMA
Middle Name:
Last Name:ABDUSSAMAD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5148 HAZEL AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-1513
Mailing Address - Country:US
Mailing Address - Phone:215-471-1117
Mailing Address - Fax:
Practice Address - Street 1:5148 HAZEL AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-1513
Practice Address - Country:US
Practice Address - Phone:215-471-1117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker