Healthcare Provider Details

I. General information

NPI: 1720942246
Provider Name (Legal Business Name): AMAL ADNAN-IBRAHIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 652 NEWARK AVE 1ST FLOOR
ELIZABETH NJ
07208
US

IV. Provider business mailing address

20 MONROE PL
STATEN ISLAND NY
10314-6914
US

V. Phone/Fax

Practice location:
  • Phone: 877-803-5342
  • Fax:
Mailing address:
  • Phone: 347-307-5107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number016659
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: