Provider Demographics
NPI:1760808794
Name:ESTOK, JESSICA (LCDP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:ESTOK
Suffix:
Gender:F
Credentials:LCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:282 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-7311
Mailing Address - Country:US
Mailing Address - Phone:302-636-0700
Mailing Address - Fax:302-636-0701
Practice Address - Street 1:282 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-7311
Practice Address - Country:US
Practice Address - Phone:302-636-0700
Practice Address - Fax:302-636-0701
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-14
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECD-0000059101YA0400X
NJ37LC00166700101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)