Provider Demographics
NPI:1962869735
Name:AL-KHABBAZ, ZAINAB ABDULAZIZ (BCBA)
Entity type:Individual
Prefix:
First Name:ZAINAB
Middle Name:ABDULAZIZ
Last Name:AL-KHABBAZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 LEDGEWOOD RD APT 409
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-6622
Mailing Address - Country:US
Mailing Address - Phone:608-335-7633
Mailing Address - Fax:
Practice Address - Street 1:1130 TEN ROD RD STE 101
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-4161
Practice Address - Country:US
Practice Address - Phone:401-294-3990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-15-19622103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst