Healthcare Provider Details

I. General information

NPI: 1639989940
Provider Name (Legal Business Name): JUAN C. ESCOBEDO MS, LPC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 STONEY BROOK LN
MARLTON NJ
08053-2438
US

IV. Provider business mailing address

322 STONEY BROOK LN
MARLTON NJ
08053-2438
US

V. Phone/Fax

Practice location:
  • Phone: 267-252-5738
  • Fax:
Mailing address:
  • Phone: 267-252-5738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC01028400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: