Provider Demographics
NPI:1255060620
Name:MAHMOUD, MARWA
Entity type:Individual
Prefix:
First Name:MARWA
Middle Name:
Last Name:MAHMOUD
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 1:1007 W BROADWAY AVE # 200
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411-2503
Mailing Address - Country:US
Mailing Address - Phone:651-728-8716
Mailing Address - Fax:612-460-9388
Practice Address - Street 1:1007 W BROADWAY AVE # 200
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411-2503
Practice Address - Country:US
Practice Address - Phone:651-728-8716
Practice Address - Fax:612-460-9388
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst