Provider Demographics
NPI:1023227501
Name:ELKADI, IMAN ABUSAUD (LCSW)
Entity type:Individual
Prefix:MRS
First Name:IMAN
Middle Name:ABUSAUD
Last Name:ELKADI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6938 GREENHILL PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-1701
Mailing Address - Country:US
Mailing Address - Phone:813-833-3475
Mailing Address - Fax:813-899-0914
Practice Address - Street 1:6914 E FOWLER AVE
Practice Address - Street 2:STE E
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-1705
Practice Address - Country:US
Practice Address - Phone:813-833-3475
Practice Address - Fax:813-899-0914
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040058921041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool