Provider Demographics
NPI:1538993662
Name:BAHOMDA, MADEORAKOUMA (MS)
Entity type:Individual
Prefix:
First Name:MADEORAKOUMA
Middle Name:
Last Name:BAHOMDA
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 PARK AVE APT 206
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017-1578
Mailing Address - Country:US
Mailing Address - Phone:973-789-4037
Mailing Address - Fax:
Practice Address - Street 1:650 PARK AVE APT 206
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-1578
Practice Address - Country:US
Practice Address - Phone:973-789-4037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00961800101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional