Provider Demographics
NPI:1609088004
Name:GOURARIE, ORA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ORA
Middle Name:
Last Name:GOURARIE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 N 3RD AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2429
Mailing Address - Country:US
Mailing Address - Phone:732-247-4205
Mailing Address - Fax:732-907-1885
Practice Address - Street 1:24 N 3RD AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2429
Practice Address - Country:US
Practice Address - Phone:732-247-4205
Practice Address - Fax:732-907-1885
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100289400103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ098553Medicare ID - Type Unspecified