Provider Demographics
NPI:1821098377
Name:KASREL, MARK A (MALPC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:KASREL
Suffix:
Gender:M
Credentials:MALPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 KINGS HWY N
Mailing Address - Street 2:STE 111
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1910
Mailing Address - Country:US
Mailing Address - Phone:856-321-0234
Mailing Address - Fax:856-321-0260
Practice Address - Street 1:1060 KINGS HWY N
Practice Address - Street 2:STE 111
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1910
Practice Address - Country:US
Practice Address - Phone:856-321-0234
Practice Address - Fax:856-321-0260
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPC00008800106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist