Provider Demographics
NPI:1174117618
Name:DEFELICE, TASHA (LPC)
Entity type:Individual
Prefix:
First Name:TASHA
Middle Name:
Last Name:DEFELICE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 LAKE ILIFF RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-9703
Mailing Address - Country:US
Mailing Address - Phone:973-862-8725
Mailing Address - Fax:
Practice Address - Street 1:164 LAKE ILIFF RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-9703
Practice Address - Country:US
Practice Address - Phone:973-862-8725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-25
Last Update Date:2024-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00476600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health