Provider Demographics
NPI:1639989940
Name:ESCOBEDO, JUAN C (MS, LPC, NCC)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:C
Last Name:ESCOBEDO
Suffix:
Gender:M
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 STONEY BROOK LN
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2438
Mailing Address - Country:US
Mailing Address - Phone:267-252-5738
Mailing Address - Fax:
Practice Address - Street 1:322 STONEY BROOK LN
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2438
Practice Address - Country:US
Practice Address - Phone:267-252-5738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC01028400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health