Individual
NICOLE G DERISI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2035 LINCOLN HWY STE 1150, EDISON, NJ 08817-3351
(866) 557-8669
Mailing address
293 COLONIA BLVD, COLONIA, NJ 07067-3025
(732) 675-1868
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-21-198035
NJ
Other
Enumeration date
02/07/2022
Last updated
02/07/2022
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