Provider Demographics
NPI:1811711765
Name:ASIF, ISHRAT JAHAN (PHD, LPC)
Entity type:Individual
Prefix:
First Name:ISHRAT
Middle Name:JAHAN
Last Name:ASIF
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 WOODDALE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-4629
Mailing Address - Country:US
Mailing Address - Phone:917-596-6682
Mailing Address - Fax:
Practice Address - Street 1:354 AVENUE C
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-1412
Practice Address - Country:US
Practice Address - Phone:201-535-5959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC01023800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health