Individual
EDISON A JAQUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4228 S BROAD ST HAMILTON TOWNSHIP NEW JERSEY, TRENTON, NJ 08620-2105
(609) 475-2560
Mailing address
10 BURGESS LN, WILLINGBORO, NJ 08046-1638
(732) 362-1897
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
37AC00871300
NJ
Other
Enumeration date
05/21/2025
Last updated
05/21/2025
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