Provider Demographics
NPI:1629304043
Name:GUEVARA, WILFORD (LPC)
Entity Type:Individual
Prefix:
First Name:WILFORD
Middle Name:
Last Name:GUEVARA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07524-1812
Mailing Address - Country:US
Mailing Address - Phone:973-214-0670
Mailing Address - Fax:973-684-5788
Practice Address - Street 1:9 W BROADWAY FL 2
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07505-1014
Practice Address - Country:US
Practice Address - Phone:973-214-0670
Practice Address - Fax:973-684-5788
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00110500101Y00000X, 101YM0800X, 101YP2500X, 101YS0200X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool