Provider Demographics
NPI:1205518503
Name:RINCON TAVAREZ, FRANK JEFFERSON
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:JEFFERSON
Last Name:RINCON TAVAREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 MERCER ST
Mailing Address - Street 2:APT.2G
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-3447
Mailing Address - Country:US
Mailing Address - Phone:628-333-1656
Mailing Address - Fax:
Practice Address - Street 1:2641 JOHN F. KENNEDY BLVD
Practice Address - Street 2:SUITE 505
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-3847
Practice Address - Country:US
Practice Address - Phone:201-632-5554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00725500101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor