Healthcare Provider Details

I. General information

NPI: 1114463999
Provider Name (Legal Business Name): POONAM V DOSHI LPC, NCC, CCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. POONAM R NAGDA

II. Dates (important events)

Enumeration Date: 01/17/2017
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1536 STATE ROUTE 23 STE 1009
WAYNE NJ
07470-7516
US

IV. Provider business mailing address

1536 STATE ROUTE 23 STE 1009
WAYNE NJ
07470-7516
US

V. Phone/Fax

Practice location:
  • Phone: 973-245-9719
  • Fax:
Mailing address:
  • Phone: 973-245-9719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00551400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: