Provider Demographics
NPI:1699812271
Name:KINCHLA, JULAINE (PHD)
Entity Type:Individual
Prefix:
First Name:JULAINE
Middle Name:
Last Name:KINCHLA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 NASSAU ST STE 509
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08542-4505
Mailing Address - Country:US
Mailing Address - Phone:609-924-5104
Mailing Address - Fax:
Practice Address - Street 1:20 NASSAU ST STE 509
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08542-4505
Practice Address - Country:US
Practice Address - Phone:609-924-5104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI00178400103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ22-2915215Medicare ID - Type Unspecified