Provider Demographics
NPI:1598462574
Name:OUCHEFOUN, KHADIDJA
Entity Type:Individual
Prefix:
First Name:KHADIDJA
Middle Name:
Last Name:OUCHEFOUN
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 1:2102 AVENUE Z
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3081
Mailing Address - Country:US
Mailing Address - Phone:347-921-3250
Mailing Address - Fax:
Practice Address - Street 1:14 HOLTEN AVE FL 2
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-3715
Practice Address - Country:US
Practice Address - Phone:327-455-5504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician