MEDICARE: TASHA DEFELICE LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	37AC00476600	NJ

General Provider Information

NPI Number	:	1174117618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TASHA DEFELICE LPC

Provider Business Mailing Address
First Line	:	164 LAKE ILIFF RD
Second Line	:
City	:	NEWTON
State	:	NJ
Zip	:	07860-9703
Country	:	US
Telephone Number	:	973-862-8725
Fax Number	:

Provider Business Practice Location Address
First Line	:	164 LAKE ILIFF RD
Second Line	:
City	:	NEWTON
State	:	NJ
Zip	:	07860-9703
Country	:	US
Telephone Number	:	973-862-8725
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2021
Last Update Date	:	02/03/2024

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Directions to “ TASHA DEFELICE LPC” Practice Location

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