Provider Demographics
NPI:1669961439
Name:RASAQ, RASHIDAT
Entity type:Individual
Prefix:
First Name:RASHIDAT
Middle Name:
Last Name:RASAQ
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 1:200 GLOVER AVE APT 304
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-4516
Mailing Address - Country:US
Mailing Address - Phone:646-266-0770
Mailing Address - Fax:
Practice Address - Street 1:80 MILL RIVER ST STE 2200
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3756
Practice Address - Country:US
Practice Address - Phone:617-420-1917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CT86051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician