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General NPI Number Information
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NPI Number | 1699813121
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Entity Type | Individual
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Provider Name | JUDITH DEREN FERLISE M.A. , LPC
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Gender | Female
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 183 FRANKLIN CORNER RD
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City | LAWRENCEVILLE
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State | NJ
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Zip | 08648-2555
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Country | US
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Telephone | 609-584-7719
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Fax | 609-584-7719
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Provider Business Mailing Address
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Address Line | 31 HOBBS RD
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City | TRENTON
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State | NJ
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Zip | 08619-3641
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Country | US
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Telephone | 609-584-7719
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Fax | 609-584-7719
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 37PC00072900
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License Number State | NJ
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