Provider Demographics
NPI:1912537689
Name:CORREIA-GUERRA, MANUELA VALVENTOS (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:MANUELA
Middle Name:VALVENTOS
Last Name:CORREIA-GUERRA
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 WARREN AVE OFC
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07762-1233
Mailing Address - Country:US
Mailing Address - Phone:732-575-0506
Mailing Address - Fax:
Practice Address - Street 1:512 WARREN AVE OFC
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07762-1233
Practice Address - Country:US
Practice Address - Phone:732-575-0506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00354800101YP2500X
NJ37PC00728200101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health