Provider Demographics
NPI:1437652294
Name:QUISPE, LEIDY
Entity Type:Individual
Prefix:
First Name:LEIDY
Middle Name:
Last Name:QUISPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 W PASSAIC ST STE 4
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07662-3000
Mailing Address - Country:US
Mailing Address - Phone:551-255-3806
Mailing Address - Fax:855-325-9859
Practice Address - Street 1:350 W PASSAIC ST STE 4
Practice Address - Street 2:
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-3000
Practice Address - Country:US
Practice Address - Phone:973-282-6299
Practice Address - Fax:855-325-9859
Is Sole Proprietor?:No
Enumeration Date:2018-03-17
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00578300106H00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist