Healthcare Provider Details

I. General information

NPI: 1669213260
Provider Name (Legal Business Name): JASNA LJUTICA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2024
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BETHANY RD STE 92
HAZLET NJ
07730-1669
US

IV. Provider business mailing address

37 DELAWARE RD
LAMBERTVILLE NJ
08530-2217
US

V. Phone/Fax

Practice location:
  • Phone: 732-313-3767
  • Fax:
Mailing address:
  • Phone: 347-693-0596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC0103800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: