Provider Demographics
NPI:1992276141
Name:SOOKBIR, PRIYA BACCHUS (LCSW)
Entity type:Individual
Prefix:
First Name:PRIYA
Middle Name:BACCHUS
Last Name:SOOKBIR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PRIYA
Other - Middle Name:
Other - Last Name:BACCHUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:110 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-4427
Mailing Address - Country:US
Mailing Address - Phone:973-777-7638
Mailing Address - Fax:973-777-9311
Practice Address - Street 1:110 MAIN AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4427
Practice Address - Country:US
Practice Address - Phone:973-777-7638
Practice Address - Fax:973-777-9311
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC057776001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty