Provider Demographics
NPI:1063871895
Name:KHSHAIBOON, SALMA HABIB (PHD)
Entity type:Individual
Prefix:
First Name:SALMA
Middle Name:HABIB
Last Name:KHSHAIBOON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 433
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-0433
Mailing Address - Country:US
Mailing Address - Phone:347-450-5320
Mailing Address - Fax:973-860-0889
Practice Address - Street 1:623 EAGLE ROCK AVE
Practice Address - Street 2:STE 1
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2948
Practice Address - Country:US
Practice Address - Phone:973-790-9222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
RIPS02223103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist