=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932950524
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SERSARAY S BASARIR ARSLAN LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2024
-----------------------------------------------------
Last Update Date | 06/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 317 ROUTE 34 STE 121B
-----------------------------------------------------
City | COLTS NECK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07722-2446
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-636-8296
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 119 STELTON RD
-----------------------------------------------------
City | PISCATAWAY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08854-2620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 37FI00224300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------