Provider Demographics
NPI:1720542657
Name:GUIJARRO, LEISLY A (CADC)
Entity Type:Individual
Prefix:MRS
First Name:LEISLY
Middle Name:A
Last Name:GUIJARRO
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 GRAND ST FL 2
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-4238
Mailing Address - Country:US
Mailing Address - Phone:201-915-2000
Mailing Address - Fax:201-915-2837
Practice Address - Street 1:395 GRAND ST FL 2
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-4238
Practice Address - Country:US
Practice Address - Phone:201-915-2000
Practice Address - Fax:201-915-2837
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)