Provider Demographics
NPI:1255936845
Name:CUCCARO-GREEN, JULIA LYNN (LPC, BC-DMT)
Entity type:Individual
Prefix:MS
First Name:JULIA
Middle Name:LYNN
Last Name:CUCCARO-GREEN
Suffix:
Gender:F
Credentials:LPC, BC-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3959 WELSH RD # 190
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-2900
Mailing Address - Country:US
Mailing Address - Phone:908-256-0892
Mailing Address - Fax:
Practice Address - Street 1:1243 GORDON RD
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3908
Practice Address - Country:US
Practice Address - Phone:908-256-0892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABC-DMT-1222225600000X
PAPC010668101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist