Provider Demographics
NPI:1558953380
Name:WARSAMEEE, OMAR ABDIFATAH
Entity Type:Individual
Prefix:PROF
First Name:OMAR
Middle Name:ABDIFATAH
Last Name:WARSAMEEE
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 1:1339 MAYNARD DR W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-2942
Mailing Address - Country:US
Mailing Address - Phone:612-532-0346
Mailing Address - Fax:
Practice Address - Street 1:3249 HENNEPIN AVE STE 60
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-3470
Practice Address - Country:US
Practice Address - Phone:612-423-3280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst