Provider Demographics
NPI:1053790568
Name:JAMA, SOREYA MOHAMUD (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:SOREYA
Middle Name:MOHAMUD
Last Name:JAMA
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:SOREYA
Other - Middle Name:
Other - Last Name:JAMA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:1710 DOUGLAS DR N STE 226X
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4371
Mailing Address - Country:US
Mailing Address - Phone:612-703-8828
Mailing Address - Fax:952-658-0434
Practice Address - Street 1:1710 DOUGLAS DR N STE 226X
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4371
Practice Address - Country:US
Practice Address - Phone:612-703-8828
Practice Address - Fax:952-658-0434
Is Sole Proprietor?:No
Enumeration Date:2015-05-29
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN229921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1053569798Medicaid