MEDICARE: DR. CHERYL SUSAN FUTTERMAN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	2740	NJ

General Provider Information

NPI Number	:	1952479990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHERYL SUSAN FUTTERMAN PH.D.

Provider Business Mailing Address
First Line	:	74 COURTER AVE
Second Line	:
City	:	MAPLEWOOD
State	:	NJ
Zip	:	07040-2820
Country	:	US
Telephone Number	:	973-378-2440
Fax Number	:	973-912-0103

Provider Business Practice Location Address
First Line	:	407 ESSEX ST
Second Line	:
City	:	MILLBURN
State	:	NJ
Zip	:	07041-1316
Country	:	US
Telephone Number	:	973-912-0102
Fax Number	:	973-912-0103

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	07/08/2007

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