Healthcare Provider Details

I. General information

NPI: 1316215791
Provider Name (Legal Business Name): JESSELLY DE LA CRUZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2011
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MORRIS AVE
UNION NJ
07083-7133
US

IV. Provider business mailing address

41 PINE ST
BEVERLY NJ
08010-3516
US

V. Phone/Fax

Practice location:
  • Phone: 201-774-4017
  • Fax:
Mailing address:
  • Phone: 201-774-4017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05484000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC0548400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: