Provider Demographics
NPI:1306603857
Name:THE DIASPORA PSYCHOLOGIST, LLC
Entity type:Organization
Organization Name:THE DIASPORA PSYCHOLOGIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHIRIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZARQA-LEDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:732-501-3449
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:CRANBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08512-0130
Mailing Address - Country:US
Mailing Address - Phone:732-501-3449
Mailing Address - Fax:888-244-7140
Practice Address - Street 1:10 SYMMES CT
Practice Address - Street 2:
Practice Address - City:CRANBURY
Practice Address - State:NJ
Practice Address - Zip Code:08512-2808
Practice Address - Country:US
Practice Address - Phone:732-501-3449
Practice Address - Fax:888-244-7140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty