Provider Demographics
NPI:1740868033
Name:MOSSALLAM, SENATH AHMED
Entity type:Individual
Prefix:
First Name:SENATH
Middle Name:AHMED
Last Name:MOSSALLAM
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 1:7212 SANDY DUNE WAY
Mailing Address - Street 2:
Mailing Address - City:ARVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11692-2020
Mailing Address - Country:US
Mailing Address - Phone:347-410-0407
Mailing Address - Fax:
Practice Address - Street 1:7212 SANDY DUNE WAY
Practice Address - Street 2:
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692-2020
Practice Address - Country:US
Practice Address - Phone:347-410-0407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011171101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health