Basic Information
Provider Information
NPI: 1134632235
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KREUSEL
FirstName: JULIANNA
MiddleName: MICHELE
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 42 DELSEA DR S
Address2:  
City: GLASSBORO
State: NJ
PostalCode: 080282621
CountryCode: US
TelephoneNumber: 8568818689
FaxNumber:  
Practice Location
Address1: 168 E BROADWAY
Address2:  
City: SALEM
State: NJ
PostalCode: 080791153
CountryCode: US
TelephoneNumber: 8568630006
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/10/2017
LastUpdateDate: 03/17/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500X  Y Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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