Individual
GUSTAVO BERNARDO MEJIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LPC, LCADC
Contact information
Practice address
61 GRAND AVE, 3RD FLOOR, ENGLEWOOD, NJ 07631-3572
(201) 245-1159
(201) 541-8100
Mailing address
150 TRYON AVE APT E1, ENGLEWOOD, NJ 07631-1670
(201) 245-1159
(201) 541-8100
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
37LC00170800
NJ
101YP2500X
Professional Counselor
Primary
37PC00396500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12063531
CAQH
—
Enumeration date
03/21/2007
Last updated
08/28/2011
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