Healthcare Provider Details

I. General information

NPI: 1356054811
Provider Name (Legal Business Name): JOANN CIURLINO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2022
Last Update Date: 12/29/2022
Certification Date: 12/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 PELICAN PL
WEST DEPTFORD NJ
08086-2242
US

IV. Provider business mailing address

37 PELICAN PL
WEST DEPTFORD NJ
08086-2242
US

V. Phone/Fax

Practice location:
  • Phone: 856-495-8707
  • Fax:
Mailing address:
  • Phone: 856-495-8707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00075200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: