Healthcare Provider Details

I. General information

NPI: 1295650554
Provider Name (Legal Business Name): MANENDRA KAUR BHUGRA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 BEACON WAY APT 522
JERSEY CITY NJ
07304-6124
US

IV. Provider business mailing address

4 BEACON WAY APT 522
JERSEY CITY NJ
07304-6124
US

V. Phone/Fax

Practice location:
  • Phone: 917-689-2380
  • Fax:
Mailing address:
  • Phone: 917-689-2380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number079690-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: