Provider Demographics
NPI:1780900571
Name:KHALID, AZZA
Entity type:Individual
Prefix:
First Name:AZZA
Middle Name:
Last Name:KHALID
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 1:1 REED ST
Mailing Address - Street 2:APT 1
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01905-1909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 REED ST
Practice Address - Street 2:APT 1
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01905-1909
Practice Address - Country:US
Practice Address - Phone:781-241-8667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health