Provider Demographics
NPI:1720538333
Name:RAMJAN, IMAAN (LSW)
Entity Type:Individual
Prefix:
First Name:IMAAN
Middle Name:
Last Name:RAMJAN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 SYNOTT PL
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07106-2812
Mailing Address - Country:US
Mailing Address - Phone:551-221-4165
Mailing Address - Fax:
Practice Address - Street 1:971 STUYVESANT AVE STE 12
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-6907
Practice Address - Country:US
Practice Address - Phone:973-306-4186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-06
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL061023001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ44SC05825800OtherLICENSED CLINICAL SOCIAL WORKER