Healthcare Provider Details

I. General information

NPI: 1831312388
Provider Name (Legal Business Name): MANDI C. HOUSER-PUSCHEL M.ED., L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 W ORMOND AVE C2
CHERRY HILL NJ
08002-3041
US

IV. Provider business mailing address

7 FAIRVIEW AVE
VOORHEES NJ
08043-1009
US

V. Phone/Fax

Practice location:
  • Phone: 856-332-3674
  • Fax:
Mailing address:
  • Phone: 856-845-8050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00393200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: