Provider Demographics
NPI:1417356270
Name:POUGH, DARNELL
Entity Type:Individual
Prefix:MR
First Name:DARNELL
Middle Name:
Last Name:POUGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 HILLE PL
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07660-2010
Mailing Address - Country:US
Mailing Address - Phone:201-567-0500
Mailing Address - Fax:
Practice Address - Street 1:40 HILLE PL
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07660-2010
Practice Address - Country:US
Practice Address - Phone:201-567-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health