Provider Demographics
NPI:1922136233
Name:GROBEL-KUCZEK, JUSTYNA (LPCMH)
Entity Type:Individual
Prefix:MRS
First Name:JUSTYNA
Middle Name:
Last Name:GROBEL-KUCZEK
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 CIGAR LOOP
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-2348
Mailing Address - Country:US
Mailing Address - Phone:443-502-2204
Mailing Address - Fax:
Practice Address - Street 1:262 CHAPMAN RD
Practice Address - Street 2:BELLEVUE BUILDING, SUITE 100
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5448
Practice Address - Country:US
Practice Address - Phone:302-292-0888
Practice Address - Fax:302-292-0889
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE0000330101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional