Provider Demographics
NPI:1710664859
Name:BLUELOCUS PSYCHOTHERAPY
Entity type:Organization
Organization Name:BLUELOCUS PSYCHOTHERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERAZ
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:SALAHUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-583-1433
Mailing Address - Street 1:42 N PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-3340
Mailing Address - Country:US
Mailing Address - Phone:973-583-1433
Mailing Address - Fax:
Practice Address - Street 1:75 OSBORNE PL
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-2921
Practice Address - Country:US
Practice Address - Phone:973-583-1433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-30
Last Update Date:2024-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1164638946Medicaid