Healthcare Provider Details

I. General information

NPI: 1174937650
Provider Name (Legal Business Name): EDNA X URGILEZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 W 3RD ST APT 1
PLAINFIELD NJ
07063-1394
US

IV. Provider business mailing address

186 MOUNTAIN AVE
WARREN NJ
07059-5125
US

V. Phone/Fax

Practice location:
  • Phone: 201-257-7527
  • Fax:
Mailing address:
  • Phone: 201-257-7527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC01250300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: