Provider Demographics
NPI:1528778230
Name:MONIRUZZAMAN, EFTAR (MHC-LP)
Entity type:Individual
Prefix:
First Name:EFTAR
Middle Name:
Last Name:MONIRUZZAMAN
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7035 BROADWAY APT C7
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-6110
Mailing Address - Country:US
Mailing Address - Phone:646-752-5034
Mailing Address - Fax:
Practice Address - Street 1:10232 65TH AVE STE GF
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1747
Practice Address - Country:US
Practice Address - Phone:347-934-6794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18-P119664-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health