Provider Demographics
NPI:1669121125
Name:MATHAUN DE INFANTE, DEVINDER KAUR
Entity type:Individual
Prefix:
First Name:DEVINDER
Middle Name:KAUR
Last Name:MATHAUN DE INFANTE
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 1:135 COLUMBIA TPKE STE 201
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-2189
Mailing Address - Country:US
Mailing Address - Phone:848-233-4369
Mailing Address - Fax:
Practice Address - Street 1:135 COLUMBIA TPKE STE 201
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-2189
Practice Address - Country:US
Practice Address - Phone:848-233-4369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00182800101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)