Provider Demographics
NPI:1598303679
Name:DERBYSHIRE, JESSICA (MA, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:DERBYSHIRE
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1168 DOGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-5926
Mailing Address - Country:US
Mailing Address - Phone:845-551-2602
Mailing Address - Fax:
Practice Address - Street 1:8540 VERREE RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-1325
Practice Address - Country:US
Practice Address - Phone:215-617-3629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-19
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF001138101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor