Provider Demographics
NPI:1013240977
Name:MOHAMED, IBRAHIM ADAM (MFT)
Entity type:Individual
Prefix:MR
First Name:IBRAHIM
Middle Name:ADAM
Last Name:MOHAMED
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 WIDENER ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-1950
Mailing Address - Country:US
Mailing Address - Phone:215-305-2705
Mailing Address - Fax:
Practice Address - Street 1:159 WIDENER ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19120-1950
Practice Address - Country:US
Practice Address - Phone:215-305-2705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No101Y00000XBehavioral Health & Social Service ProvidersCounselor