Provider Demographics
NPI:1093165193
Name:DEJEAN, JERRY (LMHC)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:
Last Name:DEJEAN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522-2834
Mailing Address - Country:US
Mailing Address - Phone:914-693-3030
Mailing Address - Fax:914-693-2155
Practice Address - Street 1:71 BROADWAY
Practice Address - Street 2:
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-2834
Practice Address - Country:US
Practice Address - Phone:914-693-3030
Practice Address - Fax:914-693-2155
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health