Provider Demographics
NPI:1730515644
Name:MOHAMMAD, ENAS (MFT)
Entity type:Individual
Prefix:MISS
First Name:ENAS
Middle Name:
Last Name:MOHAMMAD
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-3034
Mailing Address - Country:US
Mailing Address - Phone:860-938-2992
Mailing Address - Fax:
Practice Address - Street 1:50 BROOKSIDE RD
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-1402
Practice Address - Country:US
Practice Address - Phone:203-755-4490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist