Provider Demographics
NPI:1255897161
Name:MAHAMUD, BAHJO HUSSEIN (LICSW)
Entity type:Individual
Prefix:
First Name:BAHJO
Middle Name:HUSSEIN
Last Name:MAHAMUD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 E HENNEPIN AVE STE 402
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1867
Mailing Address - Country:US
Mailing Address - Phone:612-703-7465
Mailing Address - Fax:
Practice Address - Street 1:3055 OLD HIGH WAY 8 SUITE 202
Practice Address - Street 2:
Practice Address - City:ST ANTHONY
Practice Address - State:MN
Practice Address - Zip Code:55418-1432
Practice Address - Country:US
Practice Address - Phone:612-703-7465
Practice Address - Fax:651-493-2933
Is Sole Proprietor?:No
Enumeration Date:2019-02-15
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical