Provider Demographics
NPI:1669513131
Name:TRUKA, JANIS LEIGH (LPCMH)
Entity type:Individual
Prefix:MS
First Name:JANIS
Middle Name:LEIGH
Last Name:TRUKA
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 PEOPLES PLZ
Mailing Address - Street 2:SUITE 127
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-5707
Mailing Address - Country:US
Mailing Address - Phone:302-595-2380
Mailing Address - Fax:302-595-2382
Practice Address - Street 1:1400 PEOPLES PLZ
Practice Address - Street 2:SUITE 127
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5707
Practice Address - Country:US
Practice Address - Phone:302-595-2380
Practice Address - Fax:302-595-2382
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC0000230101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000022919Medicaid