Provider Demographics
NPI:1700666559
Name:MOHAMMED, AMIN A
Entity Type:Individual
Prefix:
First Name:AMIN
Middle Name:A
Last Name:MOHAMMED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 PAYNE AVE STE B2
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55130-4280
Mailing Address - Country:US
Mailing Address - Phone:651-502-2533
Mailing Address - Fax:651-288-1002
Practice Address - Street 1:925 PAYNE AVE STE B2
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130-4280
Practice Address - Country:US
Practice Address - Phone:651-802-2533
Practice Address - Fax:612-288-1002
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker