Healthcare Provider Details

I. General information

NPI: 1124575089
Provider Name (Legal Business Name): CIERA JASMINE CUEVAS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 09/10/2022
Certification Date: 09/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 GARNET DR
BURLINGTON NJ
08016-4715
US

IV. Provider business mailing address

810 GARNET DR
BURLINGTON NJ
08016-4715
US

V. Phone/Fax

Practice location:
  • Phone: 609-954-6744
  • Fax:
Mailing address:
  • Phone: 609-326-3397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00762100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: