Provider Demographics
NPI:1124711510
Name:BISHNAUTH, FARESHA (MSW)
Entity type:Individual
Prefix:
First Name:FARESHA
Middle Name:
Last Name:BISHNAUTH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 VICTOR ST
Mailing Address - Street 2:
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-6121
Mailing Address - Country:US
Mailing Address - Phone:347-860-0643
Mailing Address - Fax:
Practice Address - Street 1:8 MARCELLA AVE
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-4164
Practice Address - Country:US
Practice Address - Phone:973-736-2041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker