Healthcare Provider Details

I. General information

NPI: 1700522828
Provider Name (Legal Business Name): AHUVAH BRACHA FRIED LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2022
Last Update Date: 05/11/2022
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 FOREST AVE
PARAMUS NJ
07652-5241
US

IV. Provider business mailing address

6 FOREST AVE
PARAMUS NJ
07652-5241
US

V. Phone/Fax

Practice location:
  • Phone: 201-880-7530
  • Fax: 201-880-7529
Mailing address:
  • Phone: 201-880-7530
  • Fax: 201-880-7529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number44SL06589500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: