Provider Information for 1851154488
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JUSUP SIANTURI MA, LMHC
Sex: Male
NPI: 1851154488
Last Updated: 2024-02-05
Certification Date: 2024-02-05
Certification Date: 2024-02-05
Details
| Name | Value | ||||||||
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| NPI | 1851154488 | ||||||||
| Enumeration Date | 2024-02-05 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 8615 BROADWAY APT 9C ELMHURST, NY 11373-5835 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 8615 BROADWAY APT 9C ELMHURST, NY 11373-5835 United States Phone: 718-813-0042 | Fax: | ||||||||
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