Provider Demographics
NPI:1871382796
Name:NASRADDIN, AZZAH
Entity type:Individual
Prefix:
First Name:AZZAH
Middle Name:
Last Name:NASRADDIN
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 1:838 W SUNNYSIDE AVE APT 3W
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-6129
Mailing Address - Country:US
Mailing Address - Phone:872-239-4858
Mailing Address - Fax:312-270-8351
Practice Address - Street 1:838 W SUNNYSIDE AVE APT 3W
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-6129
Practice Address - Country:US
Practice Address - Phone:872-239-4858
Practice Address - Fax:312-270-8351
Is Sole Proprietor?:No
Enumeration Date:2025-05-06
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0293061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical