Provider Demographics
NPI:1952075384
Name:URENA, JOSETTE MARIE
Entity Type:Individual
Prefix:
First Name:JOSETTE
Middle Name:MARIE
Last Name:URENA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-2871
Mailing Address - Country:US
Mailing Address - Phone:347-668-4572
Mailing Address - Fax:
Practice Address - Street 1:757 POPLAR ST
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-2871
Practice Address - Country:US
Practice Address - Phone:347-668-4572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician