Healthcare Provider Details

I. General information

NPI: 1467176768
Provider Name (Legal Business Name): YULISA AQUINO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2022
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 BRUNSWICK ST
NEWARK NJ
07114-2009
US

IV. Provider business mailing address

21 BRUNSWICK ST
NEWARK NJ
07114-2009
US

V. Phone/Fax

Practice location:
  • Phone: 862-837-3099
  • Fax:
Mailing address:
  • Phone: 862-837-3099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number37FI00255700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: