Healthcare Provider Details

I. General information

NPI: 1104744028
Provider Name (Legal Business Name): JESSICA S LEW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 HARRISON AVE
HASBROUCK HEIGHTS NJ
07604-1006
US

IV. Provider business mailing address

158 HARRISON AVE
HASBROUCK HEIGHTS NJ
07604-1006
US

V. Phone/Fax

Practice location:
  • Phone: 201-957-0069
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC01285900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: