Provider Demographics
NPI:1316215791
Name:DE LA CRUZ, JESSELLY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JESSELLY
Middle Name:
Last Name:DE LA CRUZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 - 3RD STREET
Mailing Address - Street 2:
Mailing Address - City:HOBOKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030
Mailing Address - Country:US
Mailing Address - Phone:201-792-8200
Mailing Address - Fax:
Practice Address - Street 1:506 - 3RD STREET
Practice Address - Street 2:
Practice Address - City:HOBOKIN
Practice Address - State:NJ
Practice Address - Zip Code:07030
Practice Address - Country:US
Practice Address - Phone:201-792-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054840001041C0700X
NJ44SC05484001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical