Provider Demographics
NPI:1619273430
Name:DESAI, AMISHA (LMFT)
Entity Type:Individual
Prefix:
First Name:AMISHA
Middle Name:
Last Name:DESAI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 GUNTHERS VW
Mailing Address - Street 2:
Mailing Address - City:TOWACO
Mailing Address - State:NJ
Mailing Address - Zip Code:07082-1359
Mailing Address - Country:US
Mailing Address - Phone:201-438-1666
Mailing Address - Fax:201-215-0691
Practice Address - Street 1:184 RIVERVALE RD
Practice Address - Street 2:SUITE 5
Practice Address - City:RIVERVALE
Practice Address - State:NJ
Practice Address - Zip Code:07675-6270
Practice Address - Country:US
Practice Address - Phone:201-428-7733
Practice Address - Fax:201-215-0691
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37F100166600106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist