Provider Demographics
NPI:1255669156
Name:MOHAMED, ABDULAHI ABDI (LICSW)
Entity Type:Individual
Prefix:MR
First Name:ABDULAHI
Middle Name:ABDI
Last Name:MOHAMED
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 E LAKE ST
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-1963
Mailing Address - Country:US
Mailing Address - Phone:612-767-7770
Mailing Address - Fax:612-767-7772
Practice Address - Street 1:2700 E. LAKE STREET
Practice Address - Street 2:SUITE 2100
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406
Practice Address - Country:US
Practice Address - Phone:612-767-7770
Practice Address - Fax:612-767-7772
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-03
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN175301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1568778660Medicaid
MN800003186Medicare PIN
MNH400224536Medicare PIN