Provider Demographics
NPI:1770648834
Name:NUNEZ, JUAN FERNANDO (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:FERNANDO
Last Name:NUNEZ
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ANDERSON RD
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07885-2038
Mailing Address - Country:US
Mailing Address - Phone:973-659-1252
Mailing Address - Fax:
Practice Address - Street 1:26-07 BROADWAY
Practice Address - Street 2:SUITE 16C
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3832
Practice Address - Country:US
Practice Address - Phone:201-796-3533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00213200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional