Provider Demographics
NPI:1659950301
Name:DISIPIO, JESSICA E (LSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:E
Last Name:DISIPIO
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08048-5016
Mailing Address - Country:US
Mailing Address - Phone:609-535-5748
Mailing Address - Fax:609-667-7944
Practice Address - Street 1:668 MAIN ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08048-5016
Practice Address - Country:US
Practice Address - Phone:609-534-5014
Practice Address - Fax:609-667-7944
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06536600104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker