Provider Demographics
NPI:1417451725
Name:PATEL, POONAM D (LPC)
Entity Type:Individual
Prefix:
First Name:POONAM
Middle Name:D
Last Name:PATEL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BEAUMONT PL
Mailing Address - Street 2:
Mailing Address - City:WESTAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-6729
Mailing Address - Country:US
Mailing Address - Phone:732-986-7663
Mailing Address - Fax:
Practice Address - Street 1:14 FARBER RD STE 112
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-5913
Practice Address - Country:US
Practice Address - Phone:732-479-1519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-21
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00622500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional