Provider Demographics
NPI:1821678343
Name:MUNIZ, IVETTE
Entity Type:Individual
Prefix:
First Name:IVETTE
Middle Name:
Last Name:MUNIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-3744
Mailing Address - Country:US
Mailing Address - Phone:201-962-0255
Mailing Address - Fax:
Practice Address - Street 1:940 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-3744
Practice Address - Country:US
Practice Address - Phone:201-962-0255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty