Provider Demographics
NPI:1548834930
Name:DERIEUX, JAMES ROBERT V
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
Last Name:DERIEUX
Suffix:V
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 ROUTE 18 STE 203
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-1407
Mailing Address - Country:US
Mailing Address - Phone:732-994-3456
Mailing Address - Fax:
Practice Address - Street 1:190 ROUTE 18 STE 203
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-1407
Practice Address - Country:US
Practice Address - Phone:732-994-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJTP223-032103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program