Healthcare Provider Details

I. General information

NPI: 1144149949
Provider Name (Legal Business Name): JUANITA PEREA YEPES LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 RTE 46 W STE C209
FAIRFIELD NJ
07004-2431
US

IV. Provider business mailing address

155 CLINTON RD PO BOX 641
CALDWELL NJ
07006-6601
US

V. Phone/Fax

Practice location:
  • Phone: 732-561-8555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00981400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: