=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588405427
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NIVIN HAMADA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2024
-----------------------------------------------------
Last Update Date | 06/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1216 BROADWAY
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10001-4483
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-688-3540
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14148 84TH DR APT 5B
-----------------------------------------------------
City | BRIARWOOD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11435-2450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-756-9663
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | LP3899
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------