Provider Demographics
NPI:1235589953
Name:ABDULLAH, RASOOL (LCADC)
Entity Type:Individual
Prefix:MR
First Name:RASOOL
Middle Name:
Last Name:ABDULLAH
Suffix:
Gender:M
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S 12TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-1960
Mailing Address - Country:US
Mailing Address - Phone:973-622-4934
Mailing Address - Fax:
Practice Address - Street 1:300 S 12TH ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-1960
Practice Address - Country:US
Practice Address - Phone:973-622-4934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)