Provider Demographics
NPI:1124122247
Name:JURKOWSKI, JOAN MESMERINGER (LCPC)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:MESMERINGER
Last Name:JURKOWSKI
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3313 PAPER MILL RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:PHOENIX
Mailing Address - State:MD
Mailing Address - Zip Code:21131-1465
Mailing Address - Country:US
Mailing Address - Phone:410-790-9604
Mailing Address - Fax:
Practice Address - Street 1:3313 PAPER MILL RD
Practice Address - Street 2:SUITE 5
Practice Address - City:PHOENIX
Practice Address - State:MD
Practice Address - Zip Code:21131-1465
Practice Address - Country:US
Practice Address - Phone:410-790-9604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0271101Y00000X
MDACO998101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD002627OtherBEACON HEALTH
MD152866OtherMHNET
MD446530000Medicaid
MDR8950001OtherCAREFIRST BCBS
MD2282454OtherCIGNA