Provider Demographics
NPI:1376110791
Name:GUERIN, TIA (LPC)
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:
Last Name:GUERIN
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 1:87 NEW MONMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-2103
Mailing Address - Country:US
Mailing Address - Phone:732-241-0897
Mailing Address - Fax:
Practice Address - Street 1:87 NEW MONMOUTH RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-2103
Practice Address - Country:US
Practice Address - Phone:732-788-3189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-04
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00764000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional