MEDICARE: MS. ANN M SUABEDISSEN LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	37PC00128900	NJ

General Provider Information

NPI Number	:	1649334111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANN M SUABEDISSEN LPC

Provider Business Mailing Address
First Line	:	100 ASHURST LN
Second Line	:	SUITE 209
City	:	MOUNT HOLLY
State	:	NJ
Zip	:	08060-1202
Country	:	US
Telephone Number	:	609-306-3197
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 ASHURST LN
Second Line	:	SUITE 209
City	:	MOUNT HOLLY
State	:	NJ
Zip	:	08060-1202
Country	:	US
Telephone Number	:	609-306-3197
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	04/28/2015

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