Healthcare Provider Details

I. General information

NPI: 1003730136
Provider Name (Legal Business Name): MARIEL CORTEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

187 FAYETTE ST
PERTH AMBOY NJ
08861-4140
US

IV. Provider business mailing address

5 WHITE MEADOW RD
ROCKAWAY NJ
07866-1902
US

V. Phone/Fax

Practice location:
  • Phone: 732-410-7102
  • Fax:
Mailing address:
  • Phone: 732-427-1983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: