Provider Demographics
NPI:1174706857
Name:MOMOH, MABEL MUSU (LICSW)
Entity type:Individual
Prefix:
First Name:MABEL
Middle Name:MUSU
Last Name:MOMOH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:MABEL
Other - Middle Name:MUSU
Other - Last Name:PATEWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2100 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55119-4034
Mailing Address - Country:US
Mailing Address - Phone:651-771-1301
Mailing Address - Fax:651-771-2542
Practice Address - Street 1:2100 WILSON AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55119-4034
Practice Address - Country:US
Practice Address - Phone:651-771-1301
Practice Address - Fax:651-771-2542
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN161321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical