MEDICARE: DEBORAH ANN EJIOFOR LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	37PC00621300	NJ

General Provider Information

NPI Number	:	1164924957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH ANN EJIOFOR LPC

Provider Business Mailing Address
First Line	:	205 EAGLE ROCK AVE
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-5036
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 EAGLE ROCK AVE
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-5036
Country	:	US
Telephone Number	:	973-951-4402
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2018
Last Update Date	:	03/07/2018

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