Provider Demographics
NPI:1316750490
Name:GUEVARA, GLENDA N (MA, LAMFT)
Entity type:Individual
Prefix:
First Name:GLENDA
Middle Name:N
Last Name:GUEVARA
Suffix:
Gender:F
Credentials:MA, LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BEAUMONT TER
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-3912
Mailing Address - Country:US
Mailing Address - Phone:201-362-3520
Mailing Address - Fax:
Practice Address - Street 1:75 LEE CT
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-5500
Practice Address - Country:US
Practice Address - Phone:732-795-0850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FA00046900106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist