Provider Demographics
NPI:1609260645
Name:ZARQA-LEDERMAN, SHIRIN (MA, LPC, LCADC, BCPC)
Entity Type:Individual
Prefix:
First Name:SHIRIN
Middle Name:
Last Name:ZARQA-LEDERMAN
Suffix:
Gender:F
Credentials:MA, LPC, LCADC, BCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 HULSE ST
Mailing Address - Street 2:
Mailing Address - City:ROBBINSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08691-4146
Mailing Address - Country:US
Mailing Address - Phone:732-501-3449
Mailing Address - Fax:908-325-0465
Practice Address - Street 1:6 HULSE ST
Practice Address - Street 2:
Practice Address - City:ROBBINSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08691-4146
Practice Address - Country:US
Practice Address - Phone:732-501-3449
Practice Address - Fax:908-325-0465
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00485500101Y00000X
NJ37LC00129600101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ13519275OtherCAHQ PROVIDER ID