Provider Demographics
NPI:1962798637
Name:MUDACUMURA, JOVITHA LILI-UWASE (MA)
Entity type:Individual
Prefix:
First Name:JOVITHA
Middle Name:LILI-UWASE
Last Name:MUDACUMURA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 ULRICH CT
Mailing Address - Street 2:
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-7385
Mailing Address - Country:US
Mailing Address - Phone:717-903-3458
Mailing Address - Fax:
Practice Address - Street 1:52 S ARLINGTON AVE APT 10
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-3805
Practice Address - Country:US
Practice Address - Phone:717-903-3458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NJ37PC000613900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional