Provider Demographics
NPI:1518420041
Name:PEVERADA, AMELIA (LPC)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:PEVERADA
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 1:19 W KINCAID DR
Mailing Address - Street 2:
Mailing Address - City:WEST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-3030
Mailing Address - Country:US
Mailing Address - Phone:609-799-1513
Mailing Address - Fax:
Practice Address - Street 1:19 W KINCAID DR
Practice Address - Street 2:
Practice Address - City:WEST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08550-3030
Practice Address - Country:US
Practice Address - Phone:609-799-1513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-11
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00600200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health