Provider Demographics
NPI:1891511143
Name:NURUDEEN, BILQIS T
Entity type:Individual
Prefix:
First Name:BILQIS
Middle Name:T
Last Name:NURUDEEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3909 NOYES CIR APT 1
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-2374
Mailing Address - Country:US
Mailing Address - Phone:609-227-8294
Mailing Address - Fax:
Practice Address - Street 1:3909 NOYES CIR APT 1
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-2374
Practice Address - Country:US
Practice Address - Phone:609-227-8294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities