Provider Demographics
NPI:1316617640
Name:MUNOZ, DEISTHER
Entity type:Individual
Prefix:
First Name:DEISTHER
Middle Name:
Last Name:MUNOZ
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 1:55 UNION PL STE 220
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-2563
Mailing Address - Country:US
Mailing Address - Phone:973-393-2093
Mailing Address - Fax:
Practice Address - Street 1:24 N 3RD AVE
Practice Address - Street 2:SUITE 100C
Practice Address - City:HIGHLAND
Practice Address - State:NJ
Practice Address - Zip Code:08904
Practice Address - Country:US
Practice Address - Phone:973-393-2093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-17
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00157900101Y00000X
NJ37PC00997200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor