Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 003903 | CT |
NPI | 1083201511 |
---|---|
Provider Name | Dr. Karim Ibrahim |
First Address | New Haven, CT 06511 |
Second Address | New Haven, CT 06519-1124 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2020 |
Last Update Date | 30/12/2020 |