Provider Demographics
NPI:1497559793
Name:CORTES, MARISOL (LAC)
Entity type:Individual
Prefix:MS
First Name:MARISOL
Middle Name:
Last Name:CORTES
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:784 HIGHLAND AVE # 1
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-2408
Mailing Address - Country:US
Mailing Address - Phone:973-856-3267
Mailing Address - Fax:973-856-3267
Practice Address - Street 1:305 W 7TH ST
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-1511
Practice Address - Country:US
Practice Address - Phone:908-755-4848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00666600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health