Individual
JEROME DERRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
401 US HIGHWAY 22 W APT F, NORTH PLAINFIELD, NJ 07060-3805
(973) 652-7764
Mailing address
401 US HIGHWAY 22 W APT F, NORTH PLAINFIELD, NJ 07060-3805
(973) 652-7764
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
101YA0400X
NJ
Other
Enumeration date
11/12/2016
Last updated
11/12/2016
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