Provider Demographics
NPI:1871196832
Name:KARIM-REISCH, TAJI S (LCSW)
Entity Type:Individual
Prefix:
First Name:TAJI
Middle Name:S
Last Name:KARIM-REISCH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 BROOKFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-1804
Mailing Address - Country:US
Mailing Address - Phone:973-216-7022
Mailing Address - Fax:
Practice Address - Street 1:54 BROOKFIELD AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-1804
Practice Address - Country:US
Practice Address - Phone:973-216-7022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
NJ44SL06205200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health