Provider Demographics
NPI:1235613597
Name:HUSSEIN, INTISAR O (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:INTISAR
Middle Name:O
Last Name:HUSSEIN
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 E LAKE ST STE 209
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1849
Mailing Address - Country:US
Mailing Address - Phone:612-412-3318
Mailing Address - Fax:
Practice Address - Street 1:1600 BROADWAY ST NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-2617
Practice Address - Country:US
Practice Address - Phone:612-412-3318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN217801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical