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Provider Information for 1669852075


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Mr. ANGELO FOURAS LCSW


Sex: Male

NPI: 1669852075
Last Updated: 2015-11-10
Certification Date:

Details

NameValue
NPI1669852075
Enumeration Date2015-06-02
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 49 PARK AVE
ISELIN, NJ 08830-2241
United States

Phone: 732-887-9208 | Fax:
 
Primary Practice Address 288 RUES LN
EAST BRUNSWICK, NJ 08816-5699
United States

Phone: 732-257-6100 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 1041C0700X - Social Worker - ClinicalNJ44SC05659300