Provider Demographics
NPI:1770391583
Name:ACEBO, JULISSA CHRISTINE (LAC)
Entity type:Individual
Prefix:MISS
First Name:JULISSA
Middle Name:CHRISTINE
Last Name:ACEBO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 46TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-2911
Mailing Address - Country:US
Mailing Address - Phone:201-658-4717
Mailing Address - Fax:
Practice Address - Street 1:395 GRAND ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-4238
Practice Address - Country:US
Practice Address - Phone:201-945-2883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00836400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional