Provider Demographics
NPI:1639471816
Name:KHWAJA, MARYAM (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARYAM
Middle Name:
Last Name:KHWAJA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MARYUM
Other - Middle Name:
Other - Last Name:KHWAJA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:15349 78TH ST
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-1708
Mailing Address - Country:US
Mailing Address - Phone:718-843-6308
Mailing Address - Fax:
Practice Address - Street 1:15349 78TH ST
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-1708
Practice Address - Country:US
Practice Address - Phone:718-843-6308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0779231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical