Provider Demographics
NPI:1033312467
Name:LETIZIA, GEORAE ELENE (LPC)
Entity Type:Individual
Prefix:MS
First Name:GEORAE
Middle Name:ELENE
Last Name:LETIZIA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 SAM DR
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-4436
Mailing Address - Country:US
Mailing Address - Phone:732-272-2989
Mailing Address - Fax:732-389-4817
Practice Address - Street 1:41 SAM DR
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07724-4436
Practice Address - Country:US
Practice Address - Phone:732-272-2989
Practice Address - Fax:732-389-4817
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00358600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional