Miguel Fajardo

Individual provider Active NPI Pastoral Counselor · Hawthorne, NJ

NPI 1124630348 · NPPES record last updated Aug 19, 2020

Key facts

NPI
1124630348
Entity type
Individual (NPI type 1)
Primary specialty
Pastoral Counselor 101YP1600X
Practice address
89 3Rd Ave
Hawthorne, NJ 07506-2413
Phone
(862) 571-0274
NPI assigned
Aug 19, 2020
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pastoral Counselor
Group: 193400000X SINGLE SPECIALTY GROUP
101YP1600X Yes

Addresses

Primary practice location

89 3Rd Ave
Hawthorne, NJ 07506-2413

Mailing address

89 3Rd Ave
Hawthorne, NJ 07506-2413
Phone (862) 571-0274

Other providers in Hawthorne, NJ

All providers in Hawthorne, NJ · Pastoral Counselor in New Jersey

Sources for this page

Verify at the official NPI Registry.