Provider Demographics
NPI:1528381597
Name:HASSAN, KHADEEJAH (LPN, LICSW)
Entity Type:Individual
Prefix:
First Name:KHADEEJAH
Middle Name:
Last Name:HASSAN
Suffix:
Gender:F
Credentials:LPN, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FENN ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-6278
Mailing Address - Country:US
Mailing Address - Phone:413-629-1251
Mailing Address - Fax:
Practice Address - Street 1:20 EDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-3306
Practice Address - Country:US
Practice Address - Phone:413-446-7217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-05
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor