Healthcare Provider Details

I. General information

NPI: 1023594595
Provider Name (Legal Business Name): NUHA M MATARI LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8713 BRITTANY DR
WAYNE NJ
07470-8506
US

IV. Provider business mailing address

8713 BRITTANY DR
WAYNE NJ
07470-8506
US

V. Phone/Fax

Practice location:
  • Phone: 862-221-1468
  • Fax:
Mailing address:
  • Phone: 862-221-1468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number37PC00636800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: