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General NPI Number Information
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NPI Number | 1881318368
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Entity Type | Individual
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Provider Name | ELIZABETH DAVIE VANDUSEN MPS, ATR-BC, LPAT
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Gender | Female
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Dates
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Enumeration Date | 09/28/2022
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Last Update Date | 09/28/2022
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Provider Practice Location Address
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Address Line | 550 W MAIN ST
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City | BOONTON
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State | NJ
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Zip | 07005-1168
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Country | US
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Telephone | 917-710-2278
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Fax |
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Provider Business Mailing Address
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Address Line | 534 SUMMIT AVE
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City | MAPLEWOOD
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State | NJ
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Zip | 07040-1339
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Country | US
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Telephone | 917-710-2278
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 16LP00009200
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License Number State | NJ
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