Provider Demographics
NPI:1174609986
Name:JARUSIEWICZ, BETTY (PHD)
Entity type:Individual
Prefix:DR
First Name:BETTY
Middle Name:
Last Name:JARUSIEWICZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 CYPRESS DR
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-3110
Mailing Address - Country:US
Mailing Address - Phone:732-801-4505
Mailing Address - Fax:732-269-8385
Practice Address - Street 1:222 SERPENTINE DR
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08721-3227
Practice Address - Country:US
Practice Address - Phone:732-801-4505
Practice Address - Fax:732-269-8385
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00119700101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)