Provider Demographics
NPI:1740782986
Name:JARAMILLO, LINA (LPC)
Entity Type:Individual
Prefix:MS
First Name:LINA
Middle Name:
Last Name:JARAMILLO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 RECKLESS PL
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1750
Mailing Address - Country:US
Mailing Address - Phone:732-983-2539
Mailing Address - Fax:
Practice Address - Street 1:47 RECKLESS PL
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1750
Practice Address - Country:US
Practice Address - Phone:732-983-2539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-04
Last Update Date:2018-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00530000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional