Provider Demographics
NPI:1093082778
Name:MAHMOUD, KAMAL (MS)
Entity Type:Individual
Prefix:
First Name:KAMAL
Middle Name:
Last Name:MAHMOUD
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 N PEACH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-2626
Mailing Address - Country:US
Mailing Address - Phone:215-287-9501
Mailing Address - Fax:
Practice Address - Street 1:122 N PEACH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-2626
Practice Address - Country:US
Practice Address - Phone:215-287-9501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst