Healthcare Provider Details

I. General information

NPI: 1619806049
Provider Name (Legal Business Name): JENNIFER PINEDA LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 GRAND AVE
ENGLEWOOD NJ
07631-4369
US

IV. Provider business mailing address

285 GRAND AVE
ENGLEWOOD NJ
07631-4369
US

V. Phone/Fax

Practice location:
  • Phone: 877-537-7905
  • Fax:
Mailing address:
  • Phone: 877-537-7905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00815800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: