Healthcare Provider Details

I. General information

NPI: 1164816153
Provider Name (Legal Business Name): KAPRI NICOLE HEADLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 VALLEY RD STE 150
MONTCLAIR NJ
07042-2709
US

IV. Provider business mailing address

279 CLARK ST APT A11
HACKENSACK NJ
07601-1000
US

V. Phone/Fax

Practice location:
  • Phone: 973-375-1509
  • Fax:
Mailing address:
  • Phone: 551-284-2958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00839400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: