Healthcare Provider Details

I. General information

NPI: 1699089961
Provider Name (Legal Business Name): AZIZAH TAHIRA LLOYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2010
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 PARKSIDE RD
PLAINFIELD NJ
07060-2846
US

IV. Provider business mailing address

310 PARKSIDE RD
PLAINFIELD NJ
07060-2846
US

V. Phone/Fax

Practice location:
  • Phone: 917-533-5950
  • Fax:
Mailing address:
  • Phone: 917-533-5950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number005334
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC00791800
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: