Provider Demographics
NPI:1386180768
Name:ABDULAZIZ, TARIQ M (PHD, LADC)
Entity Type:Individual
Prefix:DR
First Name:TARIQ
Middle Name:M
Last Name:ABDULAZIZ
Suffix:
Gender:M
Credentials:PHD, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 907
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06088-0907
Mailing Address - Country:US
Mailing Address - Phone:860-377-0641
Mailing Address - Fax:860-831-1044
Practice Address - Street 1:91 SCHRAFFTS DR
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-3271
Practice Address - Country:US
Practice Address - Phone:860-377-0641
Practice Address - Fax:860-831-1044
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-10
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1227101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)