Provider Demographics
NPI:1174670665
Name:AHMED, MAISOONA MOHAMMED (SWT)
Entity type:Individual
Prefix:MS
First Name:MAISOONA
Middle Name:MOHAMMED
Last Name:AHMED
Suffix:
Gender:F
Credentials:SWT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6457 AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-3989
Mailing Address - Country:US
Mailing Address - Phone:248-521-2262
Mailing Address - Fax:313-299-6066
Practice Address - Street 1:16904 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-3505
Practice Address - Country:US
Practice Address - Phone:313-581-2787
Practice Address - Fax:313-581-7318
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6803084633104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3434247Medicaid