Provider Demographics
NPI:1558617423
Name:MISURELL, JUSTIN ROBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:ROBERT
Last Name:MISURELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 WASHINGTON ST
Mailing Address - Street 2:METRO RDTC
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-3011
Mailing Address - Country:US
Mailing Address - Phone:973-735-9370
Mailing Address - Fax:
Practice Address - Street 1:185 WASHINGTON ST
Practice Address - Street 2:METRO RDTC
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-3011
Practice Address - Country:US
Practice Address - Phone:973-735-9370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4939103TC0700X
NY019457-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical