Provider Demographics
NPI:1386011260
Name:CHOUDHURY, SURAIYA (LMHC)
Entity Type:Individual
Prefix:
First Name:SURAIYA
Middle Name:
Last Name:CHOUDHURY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:934 VAN NEST AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-4031
Mailing Address - Country:US
Mailing Address - Phone:347-840-4970
Mailing Address - Fax:
Practice Address - Street 1:9720 57TH AVE
Practice Address - Street 2:APT 18D
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-3543
Practice Address - Country:US
Practice Address - Phone:347-840-4970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-27
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009964101YM0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health