Healthcare Provider Details

I. General information

NPI: 1558296103
Provider Name (Legal Business Name): ALLAN GAMARRA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 E 4TH ST
CLIFTON NJ
07011-1637
US

IV. Provider business mailing address

262 E 4TH ST
CLIFTON NJ
07011-1637
US

V. Phone/Fax

Practice location:
  • Phone: 973-568-0158
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC00679700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: