Healthcare Provider Details

I. General information

NPI: 1689579880
Provider Name (Legal Business Name): AMELIA WASHINGTON LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 FITZHERBERT ST FL 1
BLOOMFIELD NJ
07003-4028
US

IV. Provider business mailing address

7 FITZHERBERT ST FL 1
BLOOMFIELD NJ
07003-4028
US

V. Phone/Fax

Practice location:
  • Phone: 973-510-4447
  • Fax:
Mailing address:
  • Phone: 973-510-4447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00935800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: