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General NPI Number Information
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NPI Number | 1487563771
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Entity Type | Individual
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Provider Name | JULIET VAN WAGENEN
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Gender | Female
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Dates
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Enumeration Date | 09/03/2026
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Last Update Date | 09/03/2026
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Provider Practice Location Address
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Address Line | 8705 GERMANTOWN AVE STE 3
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City | PHILADELPHIA
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State | PA
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Zip | 19118-2720
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Country | US
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Telephone | 484-300-5360
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Fax |
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Provider Business Mailing Address
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Address Line | 4831 OGLE ST
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City | PHILADELPHIA
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State | PA
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Zip | 19127-1904
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Country | US
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Telephone | 484-300-5360
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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