Provider Demographics
NPI:1336782945
Name:DIDOMENICO, TERESA JENNIFER (LPC)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:JENNIFER
Last Name:DIDOMENICO
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 1:100 GREENBRIAR RD
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1949
Mailing Address - Country:US
Mailing Address - Phone:201-444-0534
Mailing Address - Fax:
Practice Address - Street 1:100 GREENBRIAR RD
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-1949
Practice Address - Country:US
Practice Address - Phone:201-655-1354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-26
Last Update Date:2019-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00323800101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional