Provider Demographics
NPI:1740692243
Name:TARIQ, MAHAM (LPC)
Entity type:Individual
Prefix:MS
First Name:MAHAM
Middle Name:
Last Name:TARIQ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 BROADWAY # 337
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3620
Mailing Address - Country:US
Mailing Address - Phone:551-202-2857
Mailing Address - Fax:
Practice Address - Street 1:300 CONSTITUTION AVE
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-5074
Practice Address - Country:US
Practice Address - Phone:551-202-2857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional