Provider Demographics
NPI:1164074019
Name:DEPUTTER, JESSICA (LCSW, LCADC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:DEPUTTER
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-2204
Mailing Address - Country:US
Mailing Address - Phone:609-350-4760
Mailing Address - Fax:
Practice Address - Street 1:419 BETHEL RD
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2189
Practice Address - Country:US
Practice Address - Phone:609-788-4698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00282200101YA0400X
NJ44SL06021100104100000X
NJ44SC062292001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker