Provider Demographics
NPI:1902869100
Name:HOUSEL, MARY BETH (MS, ATC, CSCS)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:BETH
Last Name:HOUSEL
Suffix:
Gender:F
Credentials:MS, ATC, CSCS
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:BETH
Other - Last Name:HARBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, ATC, CSCS
Mailing Address - Street 1:354 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974-2129
Mailing Address - Country:US
Mailing Address - Phone:908-577-2262
Mailing Address - Fax:908-464-2682
Practice Address - Street 1:354 SOUTH ST
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-2129
Practice Address - Country:US
Practice Address - Phone:908-577-2262
Practice Address - Fax:908-464-2682
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001187002255A2300X
PART0033692255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer