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General NPI Number Information
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NPI Number | 1275665770
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Entity Type | Individual
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Provider Name | DR. ANGELA PROVENZANO SCHAUB
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Gender | Female
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Dates
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Enumeration Date | 03/10/2007
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Last Update Date | 08/30/2008
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Provider Practice Location Address
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Address Line | 318 ELM ST
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City | WESTFIELD
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State | NJ
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Zip | 07090-3104
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Country | US
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Telephone | 908-232-4331
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2884
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City | WESTFIELD
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State | NJ
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Zip | 07091-2884
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Country | US
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Telephone | 908-232-4331
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Fax |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 35S100238900
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License Number State | NJ
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