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General NPI Number Information
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NPI Number | 1407577125
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Entity Type | Individual
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Provider Name | SHARON GBADAMOSI LAC
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Gender | Female
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Dates
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Enumeration Date | 09/09/2022
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Last Update Date | 09/09/2022
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Provider Practice Location Address
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Address Line | 860 WYCKOFF AVE STE 206
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City | MAHWAH
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State | NJ
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Zip | 07430-3186
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Country | US
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Telephone | 551-315-3674
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Fax |
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Provider Business Mailing Address
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Address Line | 19 CREIGHTON CT
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City | FORDS
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State | NJ
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Zip | 08863-1302
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Country | US
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Telephone | 908-499-3200
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 37AC00646700
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License Number State | NJ
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