MEDICARE: SAFIYA BASHIR LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	37PC00576700	NJ

General Provider Information

NPI Number	:	1316484249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAFIYA BASHIR LPC

Provider Business Mailing Address
First Line	:	785 BROAD ST
Second Line	:
City	:	BLOOMFIELD
State	:	NJ
Zip	:	07003-2803
Country	:	US
Telephone Number	:	973-464-2004
Fax Number	:

Provider Business Practice Location Address
First Line	:	785 BROAD ST
Second Line	:
City	:	BLOOMFIELD
State	:	NJ
Zip	:	07003-2803
Country	:	US
Telephone Number	:	973-464-2004
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2017
Last Update Date	:	03/24/2017

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Directions to “ SAFIYA BASHIR LPC” Practice Location

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