Provider Demographics
NPI:1134335953
Name:CRESSMAN WATRAL, LOUISE ANN (LCSW)
Entity type:Individual
Prefix:MS
First Name:LOUISE
Middle Name:ANN
Last Name:CRESSMAN WATRAL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:LOUISE
Other - Middle Name:ANN
Other - Last Name:CRESSMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:704 A SHILOH PIKE
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08323
Mailing Address - Country:US
Mailing Address - Phone:856-451-5511
Mailing Address - Fax:856-451-3589
Practice Address - Street 1:704 A SHILOH PIKE
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08323
Practice Address - Country:US
Practice Address - Phone:856-451-5511
Practice Address - Fax:856-451-3589
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC005213001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
O25394Medicare UPIN
S75792Medicare ID - Type Unspecified