MEDICARE: MRS. JELYSA DESERIO 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	44SC05777200	NJ

General Provider Information

NPI Number	:	1437644481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JELYSA DESERIO LCSW

Provider Business Mailing Address
First Line	:	42 LORTON COURT
Second Line	:
City	:	OLD BRIDGE
State	:	NJ
Zip	:	08857
Country	:	US
Telephone Number	:	732-754-2846
Fax Number	:

Provider Business Practice Location Address
First Line	:	3010 BORDENTOWN AVE STE B2
Second Line	:
City	:	PARLIN
State	:	NJ
Zip	:	08859-1181
Country	:	US
Telephone Number	:	732-754-2846
Fax Number	:

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

Provider Enumeration Date	:	06/22/2018
Last Update Date	:	06/22/2018

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