Provider Demographics
NPI:1033446927
Name:HASAN, JAMAL AHMAD (CADAAC)
Entity Type:Individual
Prefix:MR
First Name:JAMAL
Middle Name:AHMAD
Last Name:HASAN
Suffix:
Gender:M
Credentials:CADAAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22971 SUTRO ST STE A
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-6514
Mailing Address - Country:US
Mailing Address - Phone:510-728-8600
Mailing Address - Fax:510-728-8605
Practice Address - Street 1:22971 SUTRO ST STE A
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-6514
Practice Address - Country:US
Practice Address - Phone:510-728-8600
Practice Address - Fax:510-728-8605
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC3171008101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)