Provider Demographics
NPI:1740733989
Name:HAMDAN, EMAN KAMEL (BCBA)
Entity type:Individual
Prefix:
First Name:EMAN
Middle Name:KAMEL
Last Name:HAMDAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43280 KEYSTONE LN
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3471
Mailing Address - Country:US
Mailing Address - Phone:313-645-3271
Mailing Address - Fax:
Practice Address - Street 1:27247 KINGSWOOD DR
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-3361
Practice Address - Country:US
Practice Address - Phone:313-645-3271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-23
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-19-34671103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7401000787OtherDEPARTMENT OF LICENSING AND REGULATORY AFFAIRS BUREAU OF PROFESSIONAL LICENSING
1-19-34671OtherBEHAVIOR ANALYST CERTIFICATION BOARD