Provider Demographics
NPI:1710357215
Name:GHAFFARI, POUYA (MS)
Entity Type:Individual
Prefix:MRS
First Name:POUYA
Middle Name:
Last Name:GHAFFARI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 HOES LN W
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-8021
Mailing Address - Country:US
Mailing Address - Phone:732-238-5407
Mailing Address - Fax:732-235-4771
Practice Address - Street 1:10 CORPORATE PL S
Practice Address - Street 2:SUITE 201
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-6148
Practice Address - Country:US
Practice Address - Phone:732-238-5407
Practice Address - Fax:732-235-4771
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health