Healthcare Provider Details

I. General information

NPI: 1255265203
Provider Name (Legal Business Name): ANA E JAVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANA GARCIA

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 PASSAIC AVE
NUTLEY NJ
07110-1742
US

IV. Provider business mailing address

426 PASSAIC AVE
NUTLEY NJ
07110-1742
US

V. Phone/Fax

Practice location:
  • Phone: 201-290-1796
  • Fax:
Mailing address:
  • Phone: 201-290-1796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00947700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: