Provider Demographics
NPI:1700066743
Name:BASHRI, MOSAMMAT RABEYA (BSW)
Entity Type:Individual
Prefix:MS
First Name:MOSAMMAT
Middle Name:RABEYA
Last Name:BASHRI
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 GREENLEAF ST SW APT C4
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265-3049
Mailing Address - Country:US
Mailing Address - Phone:205-419-0976
Mailing Address - Fax:256-492-5536
Practice Address - Street 1:210 GREENLEAF ST SW APT C4
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AL
Practice Address - Zip Code:36265-3049
Practice Address - Country:US
Practice Address - Phone:205-419-0976
Practice Address - Fax:256-492-5536
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker