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General NPI Number Information
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NPI Number | 1639761703
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Entity Type | Individual
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Provider Name | MUSTUFA RAJA LMHC
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Gender | Male
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Dates
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Enumeration Date | 02/09/2021
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Last Update Date | 02/10/2021
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Provider Practice Location Address
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Address Line | 11606 MYRTLE AVE
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City | RICHMOND HILL
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State | NY
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Zip | 11418-1748
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Country | US
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Telephone | 929-255-0800
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Fax |
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Provider Business Mailing Address
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Address Line | 191 GREEN VALLEY RD
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City | EAST MEADOW
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State | NY
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Zip | 11554-1521
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Country | US
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Telephone | 832-729-0372
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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 | 011083
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License Number State | NY
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