Provider Demographics
NPI:1518689298
Name:SOUMAN, MAHA (LSW)
Entity Type:Individual
Prefix:
First Name:MAHA
Middle Name:
Last Name:SOUMAN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 BLOOMFIELD AVE APT 411
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-2729
Mailing Address - Country:US
Mailing Address - Phone:862-271-6155
Mailing Address - Fax:
Practice Address - Street 1:141 BLOOMFIELD AVE APT 411
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-2729
Practice Address - Country:US
Practice Address - Phone:862-271-6155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06814900104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker