Provider Demographics
NPI:1598534547
Name:BARRETO, JORGE EDUARDO
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:EDUARDO
Last Name:BARRETO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 VOORHIS RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07035-1513
Mailing Address - Country:US
Mailing Address - Phone:862-200-1718
Mailing Address - Fax:
Practice Address - Street 1:40 VOORHIS RD
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:NJ
Practice Address - Zip Code:07035-1513
Practice Address - Country:US
Practice Address - Phone:862-200-1718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00753800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health