Most Relevant Information
Provider Data
| NPI Number: | 1003352303 |
| Provider Name: | ASHLEY DERDZIKOWSKI LAC |
| Entity Type: | Individual |
| Taxonomy Code: | 101Y00000X |
| Specialty: | Counselor |
| License Number: | 37AC00259500 |
Most Important Dates
| Enumeration Date: | 01/10/2017 |
| Last Updated: | 01/10/2017 |
Provider Practice Location
600 PAVONIA AVE
JERSEY CITY
NJ
07306
Practice Location Phone/Fax
| Phone: | 7322288060 |
| Fax: | 2012227676 |
Provider Mailing Location
600 PAVONIA AVE
JERSEY CITY
NJ
07306
Provider Mailing Phone/Fax
| Phone: | 7322288060 |
| Fax: | 2012227676 |