Individual
JENNIFER D DERISSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCADC
Contact information
Practice address
206 BERGEN AVE, KEARNY, NJ 07032-3384
(732) 210-0509
Mailing address
206 BERGEN AVE, KEARNY, NJ 07032-3384
(732) 210-0509
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
37LC00296100
—
Other
Enumeration date
11/08/2019
Last updated
11/08/2019
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