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General NPI Number Information
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NPI Number | 1861896565
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Entity Type | Organization
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Legal Business Name | DR. BETH DOROGUSKER
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Dates
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Enumeration Date | 10/09/2014
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Last Update Date | 10/09/2014
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Provider Practice Location Address
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Address Line | 10 FAIRMOUNT AVE
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City | CHATHAM
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State | NJ
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Zip | 07928-2343
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Country | US
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Telephone | 973-763-8375
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Fax |
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Provider Business Mailing Address
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Address Line | 20 PARK RD
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City | MAPLEWOOD
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State | NJ
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Zip | 07040-2216
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Country | US
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Telephone | 973-763-8375
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. BETH ALLISON DOROGUSKER
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Credential | PH.D.
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Telephone | 973-763-8375
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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 | 03595
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License Number State | NJ
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