Provider Demographics
NPI:1578156659
Name:PODOS, DARA
Entity Type:Individual
Prefix:
First Name:DARA
Middle Name:
Last Name:PODOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CAMPUS DR BLDG 100
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-1282
Mailing Address - Country:US
Mailing Address - Phone:732-617-6210
Mailing Address - Fax:
Practice Address - Street 1:100 CAMPUS DR STE 101
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-1253
Practice Address - Country:US
Practice Address - Phone:732-617-6210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
37AC00510800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health