Provider Demographics
NPI:1285412098
Name:PRUGNO, MARY FRANCES ANGELA (MSED, LAC)
Entity type:Individual
Prefix:
First Name:MARY FRANCES
Middle Name:ANGELA
Last Name:PRUGNO
Suffix:
Gender:F
Credentials:MSED, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 DUBAC RD
Mailing Address - Street 2:
Mailing Address - City:WALL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-3772
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2006 HIGHWAY NJ-71
Practice Address - Street 2:SUITE 4
Practice Address - City:SPRING LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07762
Practice Address - Country:US
Practice Address - Phone:732-919-1335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00748100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health