Individual
TIMUR PETRISHIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PC
Contact information
Practice address
2185 LEMOINE AVE STE 1G, FORT LEE, NJ 07024-6030
(877) 959-8180
(866) 535-3188
Mailing address
2185 LEMOINE AVE STE 1G, FORT LEE, NJ 07024-6030
(877) 959-8180
(866) 535-3188
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
37PC00825100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37PC00825100
STATE LICENSE
NJ
Enumeration date
07/21/2022
Last updated
07/21/2022
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