MEDICARE: MS. JESSELLY DE LA CRUZ LCSW

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	1041C0700X	Clinical Social Worker	44SC05484000	NJ
2	1041C0700X	Clinical Social Worker	44SC0548400	NJ

General Provider Information

NPI Number	:	1316215791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSELLY DE LA CRUZ LCSW

Provider Business Mailing Address
First Line	:	41 PINE ST
Second Line	:
City	:	BEVERLY
State	:	NJ
Zip	:	08010-3516
Country	:	US
Telephone Number	:	201-774-4017
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 MORRIS AVE
Second Line	:
City	:	UNION
State	:	NJ
Zip	:	07083-7133
Country	:	US
Telephone Number	:	201-774-4017
Fax Number	:

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

Provider Enumeration Date	:	12/13/2011
Last Update Date	:	12/13/2025

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