Provider Demographics
NPI:1841430998
Name:HASSAN, IMAN (BSW)
Entity Type:Individual
Prefix:MRS
First Name:IMAN
Middle Name:
Last Name:HASSAN
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 CHERRY VALLEY DR
Mailing Address - Street 2:APT P15
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-1492
Mailing Address - Country:US
Mailing Address - Phone:313-618-5741
Mailing Address - Fax:313-893-0064
Practice Address - Street 1:307 CHERRY VALLEY DR
Practice Address - Street 2:APT P15
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-1492
Practice Address - Country:US
Practice Address - Phone:313-618-5741
Practice Address - Fax:313-893-0064
Is Sole Proprietor?:No
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3434247Medicaid