Provider Demographics
NPI:1750942744
Name:YAQUB, NUMRA
Entity type:Individual
Prefix:
First Name:NUMRA
Middle Name:
Last Name:YAQUB
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 1:213 MCNAIR CIR
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18067-9196
Mailing Address - Country:US
Mailing Address - Phone:844-954-8327
Mailing Address - Fax:239-799-7671
Practice Address - Street 1:701 W BROAD ST STE 204
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-5229
Practice Address - Country:US
Practice Address - Phone:484-954-8327
Practice Address - Fax:239-799-7671
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-21
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16889101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105825700Medicaid