Provider Demographics
NPI:1811647175
Name:ANDERSON, TASHEEMA Y (MA, PHD, LPC, NCC)
Entity type:Individual
Prefix:MRS
First Name:TASHEEMA
Middle Name:Y
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MA, PHD, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 S NORTON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90018-4046
Mailing Address - Country:US
Mailing Address - Phone:201-486-1444
Mailing Address - Fax:
Practice Address - Street 1:88 PRINCETON HIGHTSTOWN RD
Practice Address - Street 2:
Practice Address - City:PRINCETON JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08550-1100
Practice Address - Country:US
Practice Address - Phone:732-982-2888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC01073400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty