=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003730136
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIEL CORTEZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2026
-----------------------------------------------------
Last Update Date | 08/10/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 187 FAYETTE ST
-----------------------------------------------------
City | PERTH AMBOY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08861-4140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-410-7102
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 WHITE MEADOW RD
-----------------------------------------------------
City | ROCKAWAY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07866-1902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-427-1983
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------