Provider Demographics
NPI:1750180626
Name:TRAORE, FADEL ISMAEL IBRAHIM
Entity type:Individual
Prefix:
First Name:FADEL
Middle Name:ISMAEL IBRAHIM
Last Name:TRAORE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16559 DORCAS ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-1648
Mailing Address - Country:US
Mailing Address - Phone:646-899-3082
Mailing Address - Fax:
Practice Address - Street 1:16559 DORCAS ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-1648
Practice Address - Country:US
Practice Address - Phone:646-899-3082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical