Provider Demographics
NPI:1629780069
Name:JORDANNE SCULLER LICENSED MENTAL HEALTH COUNSELOR
Entity Type:Organization
Organization Name:JORDANNE SCULLER LICENSED MENTAL HEALTH COUNSELOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER AND DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JORDANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-809-0454
Mailing Address - Street 1:301 E 66TH ST APT 14G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6218
Mailing Address - Country:US
Mailing Address - Phone:973-809-0454
Mailing Address - Fax:
Practice Address - Street 1:301 E 66TH ST APT 14G
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6218
Practice Address - Country:US
Practice Address - Phone:973-809-0454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health