Provider Demographics
NPI:1114976503
Name:HANIF, MOHAMMAD (LMSW)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:
Last Name:HANIF
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1980 KRISTIN DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-1425
Mailing Address - Country:US
Mailing Address - Phone:248-649-5544
Mailing Address - Fax:248-649-5544
Practice Address - Street 1:1980 KRISTIN DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-1425
Practice Address - Country:US
Practice Address - Phone:248-649-5544
Practice Address - Fax:248-649-5544
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801019810104100000X, 1041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801019810OtherSOCIAL WORKER