Provider Demographics
NPI:1487394987
Name:JESSICA PERRELLA LCSW INC
Entity type:Organization
Organization Name:JESSICA PERRELLA LCSW INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:PERRELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-456-0123
Mailing Address - Street 1:562 FOREST RD FL 2
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-1724
Mailing Address - Country:US
Mailing Address - Phone:732-439-7260
Mailing Address - Fax:
Practice Address - Street 1:717 N BEERS ST STE 2B
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1525
Practice Address - Country:US
Practice Address - Phone:908-456-0123
Practice Address - Fax:732-444-9810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-31
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty