Provider Demographics
NPI:1619603636
Name:HASSAN, EFRAH A
Entity Type:Individual
Prefix:
First Name:EFRAH
Middle Name:A
Last Name:HASSAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6040 EARLE BROWN DR STE 300
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-4523
Mailing Address - Country:US
Mailing Address - Phone:763-999-5938
Mailing Address - Fax:612-326-6160
Practice Address - Street 1:6040 EARLE BROWN DR
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2514
Practice Address - Country:US
Practice Address - Phone:763-999-5938
Practice Address - Fax:612-326-6160
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health