Provider Demographics
NPI:1154980449
Name:PURCELL, MARIE (LPC)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:PURCELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2522
Mailing Address - Country:US
Mailing Address - Phone:973-270-7833
Mailing Address - Fax:
Practice Address - Street 1:467 SPRINGFIELD AVE STE 201-202
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-2622
Practice Address - Country:US
Practice Address - Phone:908-376-9091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00605600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health