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General NPI Number Information
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NPI Number | 1942050802
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Entity Type | Individual
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Provider Name | SUSAN VANATTA
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Gender | Female
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Dates
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Enumeration Date | 03/25/2024
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Last Update Date | 03/25/2024
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Provider Practice Location Address
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Address Line | 333 IRVING AVE
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City | BRIDGETON
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State | NJ
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Zip | 08302-2123
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Country | US
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Telephone | 856-575-4371
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Fax |
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Provider Business Mailing Address
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Address Line | 5 WILLOW LN
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City | PILESGROVE
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State | NJ
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Zip | 08098-2426
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Country | US
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Telephone | 609-412-5981
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 26NR09363800
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License Number State | NJ
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