Provider Demographics
NPI:1881831808
Name:MUSTAFAA, CHANDRA LYNN III
Entity Type:Individual
Prefix:MS
First Name:CHANDRA
Middle Name:LYNN
Last Name:MUSTAFAA
Suffix:III
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 BROOME ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-3327
Mailing Address - Country:US
Mailing Address - Phone:862-576-4398
Mailing Address - Fax:
Practice Address - Street 1:211 BROOME ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-3327
Practice Address - Country:US
Practice Address - Phone:862-576-4398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical