Healthcare Provider Details

I. General information

NPI: 1639940810
Provider Name (Legal Business Name): JESSICA PERES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2024
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

461 FRELINGHUYSEN AVE
NEWARK NJ
07114-1404
US

IV. Provider business mailing address

461 FRELINGHUYSEN AVE
NEWARK NJ
07114-1404
US

V. Phone/Fax

Practice location:
  • Phone: 973-596-2850
  • Fax:
Mailing address:
  • Phone: 973-856-5906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00406200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC01150900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: