Provider Demographics
NPI:1154068534
Name:NIROOMAND, DANINE MARIE
Entity type:Individual
Prefix:
First Name:DANINE
Middle Name:MARIE
Last Name:NIROOMAND
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 1:201 BLACKWOOD CLEMENTON RD APT 1313
Mailing Address - Street 2:
Mailing Address - City:LINDENWOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-6845
Mailing Address - Country:US
Mailing Address - Phone:856-716-1074
Mailing Address - Fax:
Practice Address - Street 1:80 S MAIN RD STE 103
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-7829
Practice Address - Country:US
Practice Address - Phone:856-563-8159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJN46151537452662OtherDRIVERS LICENSE