Healthcare Provider Details

I. General information

NPI: 1992614572
Provider Name (Legal Business Name): KARINA DERISI LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 VALLEY RD # 150
MONTCLAIR NJ
07042-2709
US

IV. Provider business mailing address

136 E SPRINGTOWN RD
LONG VALLEY NJ
07853-3341
US

V. Phone/Fax

Practice location:
  • Phone: 973-375-1509
  • Fax:
Mailing address:
  • Phone: 201-719-0450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL07508600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: