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General NPI Number Information
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NPI Number | 1154497089
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Entity Type | Individual
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Provider Name | ANNAMARIA PRUSCINO PHD
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Gender | Female
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Dates
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Enumeration Date | 11/24/2006
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Last Update Date | 10/03/2023
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Provider Practice Location Address
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Address Line | 177 MAIN ST
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City | HATAWAN
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State | NJ
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Zip | 07747
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Country | US
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Telephone | 732-765-8778
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Fax | 732-765-8768
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Provider Business Mailing Address
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Address Line | 177 MAIN ST
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City | HATAWAN
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State | NJ
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Zip | 07747
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Country | US
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Telephone | 732-765-8778
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Fax | 732-765-8768
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | SI03250
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0099121
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 35SI00325000
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License Number State | NJ
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