Healthcare Provider Details

I. General information

NPI: 1811735632
Provider Name (Legal Business Name): TAMIA NICOLE HENRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 MARKET ST
ELMWOOD PARK NJ
07407-3126
US

IV. Provider business mailing address

267 WASHINGTON AVE
UNION NJ
07083-8275
US

V. Phone/Fax

Practice location:
  • Phone: 201-890-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: