MEDICARE: PAMELA KULISEK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	37AC00327000	NJ

General Provider Information

NPI Number	:	1174096366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA KULISEK

Provider Business Mailing Address
First Line	:	610 VALLEY HEALTH PLZ
Second Line	:
City	:	PARAMUS
State	:	NJ
Zip	:	07652-3607
Country	:	US
Telephone Number	:	201-265-8200
Fax Number	:

Provider Business Practice Location Address
First Line	:	611 US HIGHWAY 46 W
Second Line	:
City	:	HASBROUCK HEIGHTS
State	:	NJ
Zip	:	07604-3120
Country	:	US
Telephone Number	:	201-478-4162
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2019
Last Update Date	:	01/10/2019

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Directions to “ PAMELA KULISEK ” Practice Location

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