Provider Demographics
NPI:1598027849
Name:HUSAIN, VISHNOMA VADEVATTEE (MS, ED)
Entity Type:Individual
Prefix:
First Name:VISHNOMA
Middle Name:VADEVATTEE
Last Name:HUSAIN
Suffix:
Gender:F
Credentials:MS, ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 BAYPARK PL
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-1724
Mailing Address - Country:US
Mailing Address - Phone:917-807-4993
Mailing Address - Fax:718-715-0899
Practice Address - Street 1:1224 BAYPARK PL
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-1724
Practice Address - Country:US
Practice Address - Phone:917-807-4993
Practice Address - Fax:718-715-0899
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1885930103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst