Individual
DR. MALA DATTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.,D.
Contact information
Practice address
294-298 STATE ST STE 1, HACKENSACK, NJ 07601-5544
(201) 952-9905
Mailing address
259 MASSACHUSETTS AVE STE 1, HAWORTH, NJ 07641-1808
(201) 952-9905
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
012711
NY
103T00000X
Psychologist
Primary
01271101
NY
103T00000X
Psychologist
35S100543600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01271101
NYS LICENSE
NY
Enumeration date
10/10/2007
Last updated
11/06/2023
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