Provider Demographics
NPI:1033552872
Name:CERON, DIANA LORENA (LPC)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LORENA
Last Name:CERON
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 1:256 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-4414
Mailing Address - Country:US
Mailing Address - Phone:201-284-8040
Mailing Address - Fax:
Practice Address - Street 1:147 COLUMBIAN TURNPIKE
Practice Address - Street 2:SUIT 307
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07307
Practice Address - Country:US
Practice Address - Phone:201-284-8040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00473200106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist