Provider Demographics
NPI:1801393582
Name:PEDERNERA, THERESA M (LCSW, LCADC)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:PEDERNERA
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 WOODLAWN RD
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-2103
Mailing Address - Country:US
Mailing Address - Phone:973-980-6147
Mailing Address - Fax:973-298-2163
Practice Address - Street 1:280 NEWTON SPARTA RD STE 2
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-2775
Practice Address - Country:US
Practice Address - Phone:973-786-3535
Practice Address - Fax:973-786-1591
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00270400101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)