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General NPI Number Information
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NPI Number | 1447552419
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Entity Type | Individual
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Provider Name | JULIETTE DENISE MINE LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/24/2010
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Last Update Date | 05/05/2015
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Provider Practice Location Address
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Address Line | 3900 WOODLAND AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4551
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Country | US
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Telephone | 215-823-5800
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Fax |
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Provider Business Mailing Address
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Address Line | 5204 GLENWOOD DR
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City | PINE HILL
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State | NJ
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Zip | 08021-7625
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Country | US
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Telephone | 862-216-0517
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 44SL05612500
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC05578700
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License Number State | NJ
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