Provider Demographics
NPI:1710334909
Name:MARY C. PUSCHEL, MSW, LCSW
Entity Type:Organization
Organization Name:MARY C. PUSCHEL, MSW, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:PUSCHEL
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:609-844-0452
Mailing Address - Street 1:22 GORDON AVE
Mailing Address - Street 2:P.O. 6573
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-6573
Mailing Address - Country:US
Mailing Address - Phone:609-844-0452
Mailing Address - Fax:609-844-0518
Practice Address - Street 1:22 GORDON AVE
Practice Address - Street 2:P.O. 6573
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-6573
Practice Address - Country:US
Practice Address - Phone:609-844-0452
Practice Address - Fax:609-844-0518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ446075Medicare PIN