Healthcare Provider Details

I. General information

NPI: 1831025915
Provider Name (Legal Business Name): RADWA BAHAA MOKHTAR PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 MAPLE AVE
RED BANK NJ
07701-1726
US

IV. Provider business mailing address

195 MAPLE AVE
RED BANK NJ
07701-1726
US

V. Phone/Fax

Practice location:
  • Phone: 732-749-2438
  • Fax: 609-495-0713
Mailing address:
  • Phone: 732-749-2438
  • Fax: 609-495-0713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: