Provider Demographics
NPI:1295066843
Name:BIRNBAUN-ITZIGSOHN, CLARA PATRICIA (LPC)
Entity type:Individual
Prefix:MRS
First Name:CLARA
Middle Name:PATRICIA
Last Name:BIRNBAUN-ITZIGSOHN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KAY
Other - Middle Name:
Other - Last Name:ITZIGSOHN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:356 W CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-1945
Mailing Address - Country:US
Mailing Address - Phone:201-923-1209
Mailing Address - Fax:201-266-0051
Practice Address - Street 1:121 CEDAR LN
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4457
Practice Address - Country:US
Practice Address - Phone:201-923-1209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00398800101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor