Provider Demographics
NPI:1376141291
Name:GUZMAN, JENNFER MARIE (CADC INTERN, CPRS)
Entity Type:Individual
Prefix:MRS
First Name:JENNFER
Middle Name:MARIE
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:CADC INTERN, CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W END AVE
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-3747
Mailing Address - Country:US
Mailing Address - Phone:732-984-0213
Mailing Address - Fax:
Practice Address - Street 1:1 CORBETT WAY
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-4247
Practice Address - Country:US
Practice Address - Phone:732-380-7061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2019-000090101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health