Provider Demographics
NPI:1750667465
Name:ABDUR-RAZZAQ, MUHAMMAD L (ED M)
Entity Type:Individual
Prefix:MR
First Name:MUHAMMAD
Middle Name:L
Last Name:ABDUR-RAZZAQ
Suffix:
Gender:M
Credentials:ED M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1057 MORTON ST
Mailing Address - Street 2:
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126-2603
Mailing Address - Country:US
Mailing Address - Phone:617-892-5140
Mailing Address - Fax:
Practice Address - Street 1:1057 MORTON ST
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-2603
Practice Address - Country:US
Practice Address - Phone:617-892-5140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor