Provider Demographics
NPI:1245915453
Name:DE JESUS, RAMALISA
Entity type:Individual
Prefix:
First Name:RAMALISA
Middle Name:
Last Name:DE JESUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RAMALISA
Other - Middle Name:
Other - Last Name:DE JESUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-2404
Mailing Address - Country:US
Mailing Address - Phone:973-943-1977
Mailing Address - Fax:
Practice Address - Street 1:14 SMITH ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-2404
Practice Address - Country:US
Practice Address - Phone:973-943-1977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-16
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician