Provider Demographics
NPI:1154761450
Name:PAREJA, IVANA (EDS, LPC, LCADC)
Entity type:Individual
Prefix:
First Name:IVANA
Middle Name:
Last Name:PAREJA
Suffix:
Gender:F
Credentials:EDS, LPC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 STRAUBE CENTER BLVD
Mailing Address - Street 2:SUITE I-8C
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-1448
Mailing Address - Country:US
Mailing Address - Phone:732-207-8778
Mailing Address - Fax:
Practice Address - Street 1:108 STRAUBE CENTER BLVD
Practice Address - Street 2:SUITE I-8C
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-1448
Practice Address - Country:US
Practice Address - Phone:732-207-8778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00158900101YA0400X
NJ37PC00357400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)