Healthcare Provider Details

I. General information

NPI: 1629780069
Provider Name (Legal Business Name): JORDANNE SCULLER LICENSED MENTAL HEALTH COUNSELOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2022
Last Update Date: 12/16/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E 66TH ST APT 14G
NEW YORK NY
10065-6218
US

IV. Provider business mailing address

301 E 66TH ST APT 14G
NEW YORK NY
10065-6218
US

V. Phone/Fax

Practice location:
  • Phone: 973-809-0454
  • Fax:
Mailing address:
  • Phone: 973-809-0454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JORDANNE SCULLER
Title or Position: FOUNDER AND DIRECTOR
Credential:
Phone: 973-809-0454