Provider Demographics
NPI:1255436077
Name:DELLA PESCA, BRIAN CHARLES (LPC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:CHARLES
Last Name:DELLA PESCA
Suffix:
Gender:M
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:PO BOX 271
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07507
Mailing Address - Country:US
Mailing Address - Phone:973-980-2955
Mailing Address - Fax:201-436-1601
Practice Address - Street 1:654 AVENUE C
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BAYONUE
Practice Address - State:NJ
Practice Address - Zip Code:07002
Practice Address - Country:US
Practice Address - Phone:973-980-2955
Practice Address - Fax:201-436-1601
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJPC000331101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional