Healthcare Provider Details

I. General information

NPI: 1407769805
Provider Name (Legal Business Name): CATRIUCHA SASHA MUSCADIN LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 MEMORIAL PKWY
PHILLIPSBURG NJ
08865-1580
US

IV. Provider business mailing address

2112 ABBRUZZI AVE
BANGOR PA
18013-4035
US

V. Phone/Fax

Practice location:
  • Phone: 908-454-4770
  • Fax:
Mailing address:
  • Phone: 973-640-3713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00989600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: