Provider Demographics
NPI:1275399719
Name:MUZAMMIL, NOORULMAH
Entity Type:Individual
Prefix:
First Name:NOORULMAH
Middle Name:
Last Name:MUZAMMIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9415 ROSEBUD CT
Mailing Address - Street 2:
Mailing Address - City:MANASSAS PARK
Mailing Address - State:VA
Mailing Address - Zip Code:20111-3053
Mailing Address - Country:US
Mailing Address - Phone:571-356-1505
Mailing Address - Fax:
Practice Address - Street 1:9720 CAPITAL CT STE 404
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-2052
Practice Address - Country:US
Practice Address - Phone:571-232-3691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0134000545106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty