Provider Demographics
NPI:1538650569
Name:GUZMAN, VANESSA DE JESUS (MA, LAC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:DE JESUS
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:MA, LAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 GRAND AVE STE 2H
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-1040
Mailing Address - Country:US
Mailing Address - Phone:201-430-5811
Mailing Address - Fax:
Practice Address - Street 1:730 GRAND AVE STE 2H
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07657-1040
Practice Address - Country:US
Practice Address - Phone:201-430-5811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-24
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00725200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional