Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003224460 |
---|---|
Provider Name | Ashley Coralluzzo |
First Address | Westampton, NJ 08060-3804 |
Second Address | Westampton, NJ 08060-3804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2014 |
Last Update Date | 30/07/2014 |