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General NPI Number Information
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NPI Number | 1255936845
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Entity Type | Individual
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Provider Name | JULIA LYNN CUCCARO-GREEN LPC, BC-DMT
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Gender | Female
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Dates
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Enumeration Date | 12/01/2020
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Last Update Date | 12/01/2020
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Provider Practice Location Address
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Address Line | 1243 GORDON RD
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City | JENKINTOWN
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State | PA
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Zip | 19046-3908
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Country | US
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Telephone | 908-256-0892
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Fax |
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Provider Business Mailing Address
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Address Line | 3959 WELSH RD # 190
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City | WILLOW GROVE
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State | PA
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Zip | 19090-2900
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Country | US
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Telephone | 908-256-0892
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225600000X
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Taxonomy Name | Dance Therapist
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License Number | BC-DMT-1222
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC010668
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License Number State | PA
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