Provider Demographics
NPI:1043636632
Name:LLERENA, VICTOR (LSW)
Entity type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:
Last Name:LLERENA
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:MR
Other - First Name:VICTOR
Other - Middle Name:
Other - Last Name:LLERENA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:17 NEWARK BAY CT
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-1904
Mailing Address - Country:US
Mailing Address - Phone:201-320-8130
Mailing Address - Fax:
Practice Address - Street 1:17 NEWARK BAY CT
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-1904
Practice Address - Country:US
Practice Address - Phone:201-320-8130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-06
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC056687001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical