Healthcare Provider Details

I. General information

NPI: 1497559793
Provider Name (Legal Business Name): MARISOL CORTES LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W 7TH ST
PLAINFIELD NJ
07060-1511
US

IV. Provider business mailing address

784 HIGHLAND AVE # 1
NEWARK NJ
07104-2408
US

V. Phone/Fax

Practice location:
  • Phone: 908-755-4848
  • Fax:
Mailing address:
  • Phone: 973-856-3267
  • Fax: 973-856-3267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00666600
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: