Provider Demographics
NPI:1174189302
Name:WADUD PINKETT, ZAHARA N (LSW)
Entity Type:Individual
Prefix:
First Name:ZAHARA
Middle Name:N
Last Name:WADUD PINKETT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:ZAHARA
Other - Middle Name:N
Other - Last Name:WADUD-PINKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 VALLEY WOOD DR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-5229
Mailing Address - Country:US
Mailing Address - Phone:862-217-4401
Mailing Address - Fax:
Practice Address - Street 1:425 AMWELL RD STE 1
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-1213
Practice Address - Country:US
Practice Address - Phone:908-770-7352
Practice Address - Fax:908-431-5762
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06432700104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker