Provider Demographics
NPI:1366891186
Name:ALIHASSAN, FAROOQ (LPC)
Entity type:Individual
Prefix:
First Name:FAROOQ
Middle Name:
Last Name:ALIHASSAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 BURNET AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-4211
Mailing Address - Country:US
Mailing Address - Phone:201-737-3463
Mailing Address - Fax:
Practice Address - Street 1:86 PROSPECT ST APT 2
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-1842
Practice Address - Country:US
Practice Address - Phone:201-737-3463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00981600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ31-4011OtherMEDICARE
NJ4144007Medicaid