Provider Demographics
NPI:1154535631
Name:HASSAN, SHAGUFTA (LMFT)
Entity type:Individual
Prefix:MRS
First Name:SHAGUFTA
Middle Name:
Last Name:HASSAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 YVETTE DR
Mailing Address - Street 2:
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936-1810
Mailing Address - Country:US
Mailing Address - Phone:973-781-9494
Mailing Address - Fax:201-339-7842
Practice Address - Street 1:601 BROADWAY
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3818
Practice Address - Country:US
Practice Address - Phone:201-339-9200
Practice Address - Fax:201-339-7842
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0021806Medicaid
NJBA526562Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER