Healthcare Provider Details

I. General information

NPI: 1750113288
Provider Name (Legal Business Name): JULIAROSE FODALI LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 KINGS HWY STE C
WEST DEPTFORD NJ
08096-3164
US

IV. Provider business mailing address

636 KINGS HWY STE C
WEST DEPTFORD NJ
08096-3164
US

V. Phone/Fax

Practice location:
  • Phone: 856-433-4264
  • Fax:
Mailing address:
  • Phone: 856-433-4264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC01165400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: