Provider Demographics
NPI:1609668326
Name:ABDULWAHED, HANAN CHADI (RBT)
Entity type:Individual
Prefix:
First Name:HANAN
Middle Name:CHADI
Last Name:ABDULWAHED
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3875 SAN PABLO RD S APT 608
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-6808
Mailing Address - Country:US
Mailing Address - Phone:469-370-9864
Mailing Address - Fax:
Practice Address - Street 1:2176 PARK AVE STE 102
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5586
Practice Address - Country:US
Practice Address - Phone:904-297-0054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-437375106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician