Provider Demographics
NPI:1144819871
Name:JALLOH, HAWA UMU
Entity type:Individual
Prefix:
First Name:HAWA
Middle Name:UMU
Last Name:JALLOH
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 1:126 BUENA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-3547
Mailing Address - Country:US
Mailing Address - Phone:914-318-4686
Mailing Address - Fax:
Practice Address - Street 1:98120 QUEENS BLVD STE 1C
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4414
Practice Address - Country:US
Practice Address - Phone:914-318-4686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-17
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY19671101YA0400X
NY110120-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)