Provider Demographics
NPI:1972355337
Name:MOSED, REEM M
Entity Type:Individual
Prefix:
First Name:REEM
Middle Name:M
Last Name:MOSED
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 1:5211 MIDDLESEX ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-5019
Mailing Address - Country:US
Mailing Address - Phone:313-569-0709
Mailing Address - Fax:
Practice Address - Street 1:3200 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48120-1802
Practice Address - Country:US
Practice Address - Phone:313-569-0709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician