Provider Demographics
NPI:1659749240
Name:DUWANA, KAMAH
Entity Type:Individual
Prefix:
First Name:KAMAH
Middle Name:
Last Name:DUWANA
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:KAMAH
Other - Middle Name:
Other - Last Name:DUWANA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MHS
Mailing Address - Street 1:18 WESTLAND ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1763
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1115 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-7501
Practice Address - Country:US
Practice Address - Phone:508-521-2287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-13
Last Update Date:2015-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional