Provider Demographics
NPI:1578778619
Name:CORTEZ, RUBEN (MAC,CJC,CAS,CDA,RMA)
Entity Type:Individual
Prefix:MR
First Name:RUBEN
Middle Name:
Last Name:CORTEZ
Suffix:
Gender:M
Credentials:MAC,CJC,CAS,CDA,RMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 BRITTON AVE
Mailing Address - Street 2:
Mailing Address - City:LAURENCE HARBOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-2659
Mailing Address - Country:US
Mailing Address - Phone:732-441-4466
Mailing Address - Fax:732-441-7340
Practice Address - Street 1:166 MAIN ST
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-3104
Practice Address - Country:US
Practice Address - Phone:732-290-9040
Practice Address - Fax:732-566-0433
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ409101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional