Provider Demographics
NPI:1457375412
Name:MOHAMMED, ZORIDA (MSW)
Entity Type:Individual
Prefix:MS
First Name:ZORIDA
Middle Name:
Last Name:MOHAMMED
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-1813
Mailing Address - Country:US
Mailing Address - Phone:201-935-3322
Mailing Address - Fax:201-935-9196
Practice Address - Street 1:516 VALLEY BROOK AVE
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071-1930
Practice Address - Country:US
Practice Address - Phone:201-935-3322
Practice Address - Fax:201-935-9196
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC003900001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ657415AAFMedicare ID - Type Unspecified