Provider Demographics
NPI:1598940587
Name:MARAVELIAS-KAKOS, ANASTASIA MATINA (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:ANASTASIA
Middle Name:MATINA
Last Name:MARAVELIAS-KAKOS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MRS
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:MARAVELIAS-KAKOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:232 NORWOOD AVE
Mailing Address - Street 2:COUNSELING & PSYCHOTHERAPY FOR CHANGE, LLC
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1859
Mailing Address - Country:US
Mailing Address - Phone:732-263-1515
Mailing Address - Fax:732-263-9555
Practice Address - Street 1:232 NORWOOD AVE
Practice Address - Street 2:COUNSELING & PSYCHOTHERAPY FOR CHANGE, LLC
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1859
Practice Address - Country:US
Practice Address - Phone:732-263-1515
Practice Address - Fax:732-263-9555
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00046000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional