Healthcare Provider Details

I. General information

NPI: 1962092239
Provider Name (Legal Business Name): PERRY RASHIYD BAKARI LCADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2021
Last Update Date: 07/22/2024
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 CORNELL AVE SOUTH BUILDING 6
CHERRY HILL NJ
08002
US

IV. Provider business mailing address

900 EASTON AVE, PO BOX 6617
SOMERSET NJ
08875-6617
US

V. Phone/Fax

Practice location:
  • Phone: 856-246-4744
  • Fax: 973-571-8003
Mailing address:
  • Phone: 732-246-1347
  • Fax: 484-393-4096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37CA00165400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00364700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: