Provider Demographics
NPI:1437456308
Name:KULP, JOHANNA LEE (LSW)
Entity Type:Individual
Prefix:MRS
First Name:JOHANNA
Middle Name:LEE
Last Name:KULP
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 FORREST AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072-2218
Mailing Address - Country:US
Mailing Address - Phone:610-888-5031
Mailing Address - Fax:
Practice Address - Street 1:114 FORREST AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-2218
Practice Address - Country:US
Practice Address - Phone:610-888-5031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW127341104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker