Healthcare Provider Details

I. General information

NPI: 1003609363
Provider Name (Legal Business Name): SUSANNAH V ROSENTHAL SCHUTT RDT, MCH-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSIE SCHUTT

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2756 POST RD
WARWICK RI
02886-3077
US

IV. Provider business mailing address

2756 POST RD
WARWICK RI
02886-3077
US

V. Phone/Fax

Practice location:
  • Phone: 401-379-1103
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number833
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC00087-A
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: