Provider Demographics
NPI:1730820408
Name:JUENGER, KIRSTIE (MED)
Entity type:Individual
Prefix:
First Name:KIRSTIE
Middle Name:
Last Name:JUENGER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3477 INDIAN QUEEN LN APT 3
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1668
Mailing Address - Country:US
Mailing Address - Phone:845-764-0422
Mailing Address - Fax:
Practice Address - Street 1:123 S BROAD ST STE 1833
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19109-1026
Practice Address - Country:US
Practice Address - Phone:845-764-0422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health