Provider Demographics
NPI:1720329576
Name:RODRIGUES PEREIRA, JEDIEDJAH MOSHE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:JEDIEDJAH
Middle Name:MOSHE
Last Name:RODRIGUES PEREIRA
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 TODD CT
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-2256
Mailing Address - Country:US
Mailing Address - Phone:732-814-4648
Mailing Address - Fax:
Practice Address - Street 1:1212 TODD CT
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-2256
Practice Address - Country:US
Practice Address - Phone:732-814-4648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-04
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC056055001041C0700X
NJ37LC0021100103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)