Basic Information
| Provider Information | |||||||||
| NPI: | 1194109975 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REBUSTES | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | BULLECER | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | MA, LAC, NCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1173 | ||||||||
| Address2: | |||||||||
| City: | UNION | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070831173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9089627413 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1945 CORLIES AVE | ||||||||
| Address2: | |||||||||
| City: | NEPTUNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077534859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327762325 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2015 | ||||||||
| LastUpdateDate: | 07/12/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 37AC00240900 | NJ | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.