Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 5167 | NJ |
NPI | 1033540034 |
---|---|
Provider Name | Dr. Komal Dutt |
First Address | Basking Ridge, NJ 07920-2937 |
Second Address | Basking Ridge, NJ 07920-2338 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2013 |
Last Update Date | 20/12/2017 |