Provider Demographics
NPI:1780205096
Name:LIGUORI, JESSICA DENISE
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:DENISE
Last Name:LIGUORI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 RED TAILED HAWK LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-2210
Mailing Address - Country:US
Mailing Address - Phone:732-614-8437
Mailing Address - Fax:
Practice Address - Street 1:202 RED TAILED HAWK LN
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-2210
Practice Address - Country:US
Practice Address - Phone:732-614-8437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-28
Last Update Date:2020-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE11938896103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty