Provider Demographics
NPI:1275749640
Name:BALUCH, SURAIYA PARWIN (PHD)
Entity Type:Individual
Prefix:
First Name:SURAIYA
Middle Name:PARWIN
Last Name:BALUCH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:759 PRESIDENT ST
Mailing Address - Street 2:#2E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-1363
Mailing Address - Country:US
Mailing Address - Phone:718-230-7068
Mailing Address - Fax:
Practice Address - Street 1:440 W END AVE
Practice Address - Street 2:SUITE 1D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-5358
Practice Address - Country:US
Practice Address - Phone:917-626-3899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016290103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist