Provider Demographics
NPI:1063123941
Name:VINUEZA, ALEXA P
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:P
Last Name:VINUEZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-1484
Mailing Address - Country:US
Mailing Address - Phone:973-280-7196
Mailing Address - Fax:
Practice Address - Street 1:123 WANAQUE AVE
Practice Address - Street 2:
Practice Address - City:POMPTON LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07442-2101
Practice Address - Country:US
Practice Address - Phone:973-858-8163
Practice Address - Fax:973-329-0555
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06719500104100000X
NJ37LC00304500101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker