Basic Information
| Provider Information | |||||||||
| NPI: | 1013432657 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHABAZZ | ||||||||
| FirstName: | ADONAI | ||||||||
| MiddleName: | QUALITY | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9114 37TH AVE | ||||||||
| Address2: | |||||||||
| City: | JACKSON HEIGHTS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113727920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187791600 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2488 GRAND CONCOURSE RM 417 | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185847204 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2017 | ||||||||
| LastUpdateDate: | 08/14/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 101610 | NY | N | Behavioral Health & Social Service Providers | Social Worker | 104100000X | 101610-1 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.