Provider Demographics
NPI:1861533341
Name:VERGEL, JESENIA
Entity type:Individual
Prefix:
First Name:JESENIA
Middle Name:
Last Name:VERGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-1103
Mailing Address - Country:US
Mailing Address - Phone:201-795-8375
Mailing Address - Fax:201-418-7074
Practice Address - Street 1:179 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1103
Practice Address - Country:US
Practice Address - Phone:201-795-8375
Practice Address - Fax:201-418-7074
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00340800101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional