Provider Demographics
NPI:1457643173
Name:NAZARIO, JUANITA (MS, LPC, LCADC)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:
Last Name:NAZARIO
Suffix:
Gender:F
Credentials:MS, LPC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 S DELSEA DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08312-2203
Mailing Address - Country:US
Mailing Address - Phone:856-899-7130
Mailing Address - Fax:856-863-3501
Practice Address - Street 1:249 S DELSEA DR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NJ
Practice Address - Zip Code:08312-2203
Practice Address - Country:US
Practice Address - Phone:856-899-7130
Practice Address - Fax:856-863-3501
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00014700101YA0400X
NJ37PC00411800101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)