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General NPI Number Information
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NPI Number | 1730652264
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Entity Type | Individual
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Provider Name | SUSANNE PITAK DAVIS LPC 01178
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Gender | Female
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Dates
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Enumeration Date | 01/08/2019
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Last Update Date | 01/08/2019
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Provider Practice Location Address
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Address Line | 8 GRANT AVE
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City | LAMBERTVILLE
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State | NJ
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Zip | 08530-2304
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Country | US
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Telephone | 609-947-3057
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Fax |
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Provider Business Mailing Address
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Address Line | 8 GRANT AVE
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City | LAMBERTVILLE
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State | NJ
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Zip | 08530-2304
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Country | US
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Telephone | 609-947-3057
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 37PC001178000
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License Number State | NJ
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