Provider Demographics
NPI:1366742983
Name:JIANG, XIAOLU (PSYD)
Entity type:Individual
Prefix:DR
First Name:XIAOLU
Middle Name:
Last Name:JIANG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 BIRCHFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-4005
Mailing Address - Country:US
Mailing Address - Phone:856-291-6514
Mailing Address - Fax:
Practice Address - Street 1:301 BIRCHFIELD DR
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-4005
Practice Address - Country:US
Practice Address - Phone:856-291-6514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-29
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017327103TC0700X
NJ35SI00551400103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical