Provider Demographics
NPI:1043991870
Name:IROMUANYA, CHITURU N (MA)
Entity type:Individual
Prefix:
First Name:CHITURU
Middle Name:N
Last Name:IROMUANYA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 VOSE AVE UNIT 592
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-6426
Mailing Address - Country:US
Mailing Address - Phone:862-754-5962
Mailing Address - Fax:
Practice Address - Street 1:31 VOSE AVE UNIT 592
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-6426
Practice Address - Country:US
Practice Address - Phone:862-754-5962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-25
Last Update Date:2024-06-14
Deactivation Date:2024-06-06
Deactivation Code:
Reactivation Date:2024-06-14
Provider Licenses
StateLicense IDTaxonomies
NJ883514106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician