Healthcare Provider Details

I. General information

NPI: 1407782717
Provider Name (Legal Business Name): ROXANA PEREZ NIEVES LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 BETHEL RD STE C-2
SOMERS POINT NJ
08244-2184
US

IV. Provider business mailing address

4326 HARBOR BEACH BLVD UNIT 835
BRIGANTINE NJ
08203-8030
US

V. Phone/Fax

Practice location:
  • Phone: 609-788-0199
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00688900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: