Provider Information for 1598940587
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Mrs. ANASTASIA MATINA MARAVELIAS-KAKOS MA, LPC
Other Names:Other Name:Mrs. STACY MARAVELIAS-KAKOS MA, LPCSex: Female
NPI: 1598940587
Last Updated: 2008-01-08
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1598940587 | ||||||||
| Enumeration Date | 2008-01-08 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 232 NORWOOD AVE COUNSELING & PSYCHOTHERAPY FOR CHANGE, LLC WEST LONG BRANCH, NJ 07764-1859 United States Phone: 732-263-1515 | Fax:732-263-9555 | ||||||||
| Primary Practice Address | 232 NORWOOD AVE COUNSELING & PSYCHOTHERAPY FOR CHANGE, LLC WEST LONG BRANCH, NJ 07764-1859 United States Phone: 732-263-1515 | Fax:732-263-9555 | ||||||||
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