Provider Demographics
NPI:1578184198
Name:TRUCILLO, JESSICA ANN (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:TRUCILLO
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-1715
Mailing Address - Country:US
Mailing Address - Phone:732-710-2951
Mailing Address - Fax:
Practice Address - Street 1:109 HENRY ST
Practice Address - Street 2:
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879-1715
Practice Address - Country:US
Practice Address - Phone:917-485-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013139101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health