Provider Demographics
NPI:1588760045
Name:GILCH PESANTEZ, JESSICA (PSY D)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GILCH PESANTEZ
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 DANIEL AVE
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-2717
Mailing Address - Country:US
Mailing Address - Phone:201-893-9932
Mailing Address - Fax:
Practice Address - Street 1:120 DANIEL AVE
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-2717
Practice Address - Country:US
Practice Address - Phone:201-893-9932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016127103TC0700X
NJ35SI00473100103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical