Healthcare Provider Details

I. General information

NPI: 1922939370
Provider Name (Legal Business Name): FATMATA BRIDGET JUSU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 BONNIE CT APT 10
SMYRNA DE
19977-7735
US

IV. Provider business mailing address

64 BONNIE CT APT 10
SMYRNA DE
19977-7735
US

V. Phone/Fax

Practice location:
  • Phone: 302-359-2717
  • Fax:
Mailing address:
  • Phone: 302-359-2717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLG200004635
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: