Healthcare Provider Details

I. General information

NPI: 1770827453
Provider Name (Legal Business Name): NATALIE J PURNELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2012
Last Update Date: 11/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 BEAR TAVERN RD
EWING NJ
08628-1020
US

IV. Provider business mailing address

610 RADNOR AVE
HADDONFIELD NJ
08033-1006
US

V. Phone/Fax

Practice location:
  • Phone: 800-370-3651
  • Fax: 860-510-0020
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05159800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: