Provider Demographics
NPI:1417567876
Name:SHAHEED, YUSUF NATHANIEL (LCADC)
Entity type:Individual
Prefix:
First Name:YUSUF
Middle Name:NATHANIEL
Last Name:SHAHEED
Suffix:
Gender:M
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 HOBSON ST FL 2
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07112-1308
Mailing Address - Country:US
Mailing Address - Phone:973-763-8123
Mailing Address - Fax:
Practice Address - Street 1:2130 MILLBURN AVE STE D1
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3749
Practice Address - Country:US
Practice Address - Phone:973-763-8123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ37LC00208500OtherPROFESSIONAL LICENSE