Provider Demographics
NPI:1801628656
Name:HASSAN, ABDULBASID ABDULLAHI
Entity type:Individual
Prefix:
First Name:ABDULBASID
Middle Name:ABDULLAHI
Last Name:HASSAN
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 1:967 5TH ST E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-5231
Mailing Address - Country:US
Mailing Address - Phone:315-450-7121
Mailing Address - Fax:651-389-0540
Practice Address - Street 1:3110 BLAISDELL AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-3100
Practice Address - Country:US
Practice Address - Phone:315-450-7121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities