Provider Demographics
NPI:1528826773
Name:PIERRE-JACQUES, DEJA SIMONE (MSW, LSW)
Entity type:Individual
Prefix:
First Name:DEJA
Middle Name:SIMONE
Last Name:PIERRE-JACQUES
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:MRS
Other - First Name:DEJA
Other - Middle Name:
Other - Last Name:DEWITT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LSW
Mailing Address - Street 1:3175 DATA DR APT 1226
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-6441
Mailing Address - Country:US
Mailing Address - Phone:708-600-7170
Mailing Address - Fax:
Practice Address - Street 1:10535 HOSPITAL WAY
Practice Address - Street 2:
Practice Address - City:MATHER
Practice Address - State:CA
Practice Address - Zip Code:95655-4200
Practice Address - Country:US
Practice Address - Phone:916-937-3491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.1062631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical