Provider Demographics
NPI:1255639688
Name:CEA-ARAVENA, JUAN (MA)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:
Last Name:CEA-ARAVENA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:378 SAPIR ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-3831
Mailing Address - Country:US
Mailing Address - Phone:516-872-7207
Mailing Address - Fax:
Practice Address - Street 1:550 MAMARONECK AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-1634
Practice Address - Country:US
Practice Address - Phone:914-381-3409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003440101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health