Provider Demographics
NPI:1356482889
Name:IGLESIAS, JUAN J (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:J
Last Name:IGLESIAS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-3036
Mailing Address - Country:US
Mailing Address - Phone:908-654-1258
Mailing Address - Fax:908-654-1384
Practice Address - Street 1:504 MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-3036
Practice Address - Country:US
Practice Address - Phone:908-654-1258
Practice Address - Fax:908-654-1384
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC000127001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical