Provider Demographics
NPI:1790532497
Name:TEJEDA, ILONKA E (NBCC, LAC, LCADC)
Entity type:Individual
Prefix:
First Name:ILONKA
Middle Name:E
Last Name:TEJEDA
Suffix:
Gender:F
Credentials:NBCC, LAC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 MARCY AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017-3421
Mailing Address - Country:US
Mailing Address - Phone:917-721-4121
Mailing Address - Fax:
Practice Address - Street 1:92 MARCY AVE
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-3421
Practice Address - Country:US
Practice Address - Phone:917-721-4121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00774400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health