Healthcare Provider Details

I. General information

NPI: 1700485331
Provider Name (Legal Business Name): AMANDA CHAVEZ-LOYO LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2020
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 RIVER RD STE 170
EDGEWATER NJ
07020-1171
US

IV. Provider business mailing address

725 RIVER RD STE 170
EDGEWATER NJ
07020-1171
US

V. Phone/Fax

Practice location:
  • Phone: 201-632-1031
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC00925800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: