Individual
IRINA BASHKIROV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
440 WEST ST STE 323, FORT LEE, NJ 07024-5028
(917) 667-0242
Mailing address
121 CHADWICK RD, TEANECK, NJ 07666-4203
(917) 667-0242
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
37AC00246600
NJ
Other
Enumeration date
04/14/2015
Last updated
04/14/2015
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