Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | NJ | |
N | 103TC1900X | Counseling Psychologist | NJ | |
N | 103TP2701X | Group Psychotherapist | NJ |
NPI | 1396130712 |
---|---|
Provider Name | Mr. Faheem Mumin Nuruddin |
First Address | East Orange, NJ 07018 |
Second Address | East Orange, NJ 07018 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2015 |
Last Update Date | 02/04/2015 |