Provider Demographics
NPI:1376265868
Name:MAHMOUD, NEIVEIN (BACB 1-22-61317)
Entity Type:Individual
Prefix:
First Name:NEIVEIN
Middle Name:
Last Name:MAHMOUD
Suffix:
Gender:F
Credentials:BACB 1-22-61317
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 LAKEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-4111
Mailing Address - Country:US
Mailing Address - Phone:732-527-2788
Mailing Address - Fax:
Practice Address - Street 1:1103 LAKEWOOD RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-4111
Practice Address - Country:US
Practice Address - Phone:732-527-2788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-22-61317103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst