Provider Demographics
NPI:1699813121
Name:FERLISE, JUDITH DEREN (MA , LPC)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:DEREN
Last Name:FERLISE
Suffix:
Gender:F
Credentials:MA , LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 HOBBS RD
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-3641
Mailing Address - Country:US
Mailing Address - Phone:609-584-7719
Mailing Address - Fax:609-584-7719
Practice Address - Street 1:183 FRANKLIN CORNER RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2555
Practice Address - Country:US
Practice Address - Phone:609-584-7719
Practice Address - Fax:609-584-7719
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00072900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health