=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205622628
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEA MORADI-DEVITT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2025
-----------------------------------------------------
Last Update Date | 04/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3535 QUAKERBRIDGE RD STE 300
-----------------------------------------------------
City | HAMILTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08619-1200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-631-5410
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 CABOT DR APT 238
-----------------------------------------------------
City | HAMILTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08691-3205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-313-8463
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 37AC00784900
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------