Provider Demographics
NPI:1164076352
Name:OTHMAN, AMAL (LICSW)
Entity Type:Individual
Prefix:
First Name:AMAL
Middle Name:
Last Name:OTHMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 S PATERSON ST STE 352
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-4501
Mailing Address - Country:US
Mailing Address - Phone:206-939-0909
Mailing Address - Fax:
Practice Address - Street 1:211 S PATERSON ST STE 352
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-4501
Practice Address - Country:US
Practice Address - Phone:206-939-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-26
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW609582751041C0700X
WI8582-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical