Provider Demographics
NPI:1013173657
Name:SALAHUDDIN, SAMINA
Entity type:Individual
Prefix:
First Name:SAMINA
Middle Name:
Last Name:SALAHUDDIN
Suffix:
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 1:289 MOUNT PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1009
Mailing Address - Country:US
Mailing Address - Phone:973-246-7802
Mailing Address - Fax:973-470-2325
Practice Address - Street 1:1149 BLOMMFIELD AVE.
Practice Address - Street 2:CREATIVE INTERVENTION
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-2314
Practice Address - Country:US
Practice Address - Phone:973-365-2300
Practice Address - Fax:973-365-0868
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00373400103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling