Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 37AC00259500 | NJ |
NPI | 1003352303 |
---|---|
Provider Name | Ashley Derdzikowski |
First Address | Jersey City, NJ 07306 |
Second Address | Jersey City, NJ 07306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2017 |
Last Update Date | 10/01/2017 |