Provider Demographics
NPI:1568839769
Name:MUSTAFA, SAKINAH (MS, LBSC)
Entity Type:Individual
Prefix:
First Name:SAKINAH
Middle Name:
Last Name:MUSTAFA
Suffix:
Gender:F
Credentials:MS, LBSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 HOLLENBACH ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19601-2402
Mailing Address - Country:US
Mailing Address - Phone:484-721-4411
Mailing Address - Fax:484-721-4411
Practice Address - Street 1:306 HOLLENBACH ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601-2402
Practice Address - Country:US
Practice Address - Phone:484-721-4411
Practice Address - Fax:484-721-4411
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH001154103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst