Healthcare Provider Details

I. General information

NPI: 1083539266
Provider Name (Legal Business Name): JEFFREY KLUCSARITS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JEFF KLUCSARITS

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 E ELIZABETH AVE STE 300
BETHLEHEM PA
18018-6506
US

IV. Provider business mailing address

65 E ELIZABETH AVE STE 300
BETHLEHEM PA
18018-6506
US

V. Phone/Fax

Practice location:
  • Phone: 484-350-6256
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC002724
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: