Provider Demographics
NPI:1104982271
Name:ESRALEW, LUCILLE (CP)
Entity type:Individual
Prefix:
First Name:LUCILLE
Middle Name:
Last Name:ESRALEW
Suffix:
Gender:F
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7F DENNISON DR
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-5214
Mailing Address - Country:US
Mailing Address - Phone:609-443-0452
Mailing Address - Fax:
Practice Address - Street 1:707 ALEXANDER RD
Practice Address - Street 2:SUITE 208
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-6331
Practice Address - Country:US
Practice Address - Phone:609-419-4409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100396800103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ886088Medicaid
NJ886088Medicaid