Provider Demographics
NPI:1497296545
Name:DARWISH, BASEM
Entity Type:Individual
Prefix:MR
First Name:BASEM
Middle Name:
Last Name:DARWISH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 MONTERREY AVE
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-3142
Mailing Address - Country:US
Mailing Address - Phone:443-769-4409
Mailing Address - Fax:504-667-6620
Practice Address - Street 1:67 MONTERREY AVE
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-3142
Practice Address - Country:US
Practice Address - Phone:443-769-4409
Practice Address - Fax:504-667-6620
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMHC394101YM0800X
CT002706101YP2500X
IL178.011508101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health