Healthcare Provider Details

I. General information

NPI: 1609739549
Provider Name (Legal Business Name): JESSICA JOAN TESTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 BIRCH ST
BOONTON NJ
07005-1203
US

IV. Provider business mailing address

64 HUTTON RD
CLIFTON NJ
07013-3615
US

V. Phone/Fax

Practice location:
  • Phone: 973-508-0044
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00727600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: