Provider Demographics
NPI:1457899411
Name:MCBRIDE, TAKIA MARY I (N/A)
Entity Type:Individual
Prefix:MS
First Name:TAKIA
Middle Name:MARY
Last Name:MCBRIDE
Suffix:I
Gender:F
Credentials:N/A
Other - Prefix:MS
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:N/A
Mailing Address - Street 1:770 WOODLANE RD
Mailing Address - Street 2:N/A
Mailing Address - City:WESTAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-3804
Mailing Address - Country:US
Mailing Address - Phone:609-267-5928
Mailing Address - Fax:866-362-4769
Practice Address - Street 1:770 WOODLANE RD
Practice Address - Street 2:N/A
Practice Address - City:WESTAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08060-3804
Practice Address - Country:US
Practice Address - Phone:609-267-5928
Practice Address - Fax:866-362-4769
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health