Provider Information for 1003515503
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MARY T DERIENZO LPC
Other Names:Other Name:MARI DERIENZOSex: Female
NPI: 1003515503
Last Updated: 2023-02-23
Certification Date: 2023-02-23
Certification Date: 2023-02-23
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1003515503 | ||||||||
| Enumeration Date | 2023-02-23 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 818 CENTER ST GARWOOD, NJ 07027-1416 United States Phone: 908-670-7768 | Fax: | ||||||||
| Primary Practice Address | 818 CENTER ST GARWOOD, NJ 07027-1416 United States Phone: 908-670-7768 | Fax: | ||||||||
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