Healthcare Provider Details

I. General information

NPI: 1578361572
Provider Name (Legal Business Name): VIRGINIA EULACIO CIERNIAK MA, LCAT, MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VIRGINIA CAROLINA EULACIO-GUEVARA MA, MT-BC

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 FRANKLIN ST
LITTLE FERRY NJ
07643-1215
US

IV. Provider business mailing address

178 FRANKLIN ST
LITTLE FERRY NJ
07643-1215
US

V. Phone/Fax

Practice location:
  • Phone: 317-289-0664
  • Fax:
Mailing address:
  • Phone: 317-289-0664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number002787
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number12820
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: