Provider Demographics
NPI:1265739726
Name:ABDUL-LATEEF, WAHEEDAH (COUNSELOR AIDE-CHILD)
Entity type:Individual
Prefix:
First Name:WAHEEDAH
Middle Name:
Last Name:ABDUL-LATEEF
Suffix:
Gender:F
Credentials:COUNSELOR AIDE-CHILD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702-1701
Mailing Address - Country:US
Mailing Address - Phone:203-755-1143
Mailing Address - Fax:203-755-1447
Practice Address - Street 1:79 BEACON ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06704-3424
Practice Address - Country:US
Practice Address - Phone:203-574-3311
Practice Address - Fax:203-574-3315
Is Sole Proprietor?:No
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker