Provider Demographics
NPI:1639674187
Name:MOKADDAM, MONA
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:
Last Name:MOKADDAM
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 1:7501 RIDGE BLVD APT 1L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-2922
Mailing Address - Country:US
Mailing Address - Phone:718-288-9003
Mailing Address - Fax:
Practice Address - Street 1:7501 RIDGE BLVD APT 1L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-2922
Practice Address - Country:US
Practice Address - Phone:718-288-9003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101714-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker