Provider Demographics
NPI:1134384688
Name:DERUYTER SWART, JAMIE (LPC)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:DERUYTER SWART
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 WILLOWBROOK BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-7033
Mailing Address - Country:US
Mailing Address - Phone:973-506-9231
Mailing Address - Fax:
Practice Address - Street 1:155 WILLOWBROOK BLVD STE 110
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-7033
Practice Address - Country:US
Practice Address - Phone:973-506-9231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3744101YP2500X
NJ37PC00866300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional