Individual
JACKELINE GUEVARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1 LUPTON AVE, WOODBURY, NJ 08096-5901
(856) 693-5775
Mailing address
1 LUPTON AVE, WOODBURY, NJ 08096-5901
(856) 693-5775
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
44SC06318100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1012819
—
NJ
Enumeration date
06/17/2024
Last updated
08/20/2024
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