Healthcare Provider Details

I. General information

NPI: 1619605334
Provider Name (Legal Business Name): ERIKA MAKUTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 ATLANTIC AVE STE 2
MANASQUAN NJ
08736-1147
US

IV. Provider business mailing address

1707 ATLANTIC AVE STE 2
MANASQUAN NJ
08736-1147
US

V. Phone/Fax

Practice location:
  • Phone: 732-606-4634
  • Fax:
Mailing address:
  • Phone: 732-606-4634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37AC00604600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: