Provider Demographics
NPI:1790116226
Name:JURUSZ, STEPHANIE (LSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:JURUSZ
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 1:651 WILLOW GROVE ST
Mailing Address - Street 2:HACKETTSTOWN REGIONAL MEDICAL CENTER
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840
Mailing Address - Country:US
Mailing Address - Phone:908-850-6809
Mailing Address - Fax:908-850-6846
Practice Address - Street 1:651 WILLOW GROVE ST
Practice Address - Street 2:HACKETTSTOWN REGIONAL MEDICAL CENTER
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840
Practice Address - Country:US
Practice Address - Phone:908-850-6809
Practice Address - Fax:908-850-6846
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL04858100104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker