Provider Demographics
NPI:1487466033
Name:MALLOUHI, ELI (LSW)
Entity type:Individual
Prefix:
First Name:ELI
Middle Name:
Last Name:MALLOUHI
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 PATRICK AVE
Mailing Address - Street 2:
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630-1462
Mailing Address - Country:US
Mailing Address - Phone:201-270-6368
Mailing Address - Fax:
Practice Address - Street 1:545 ISLAND RD STE 2B
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-2822
Practice Address - Country:US
Practice Address - Phone:201-995-1004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL066394001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical