Provider Demographics
NPI:1285854638
Name:DOROGUSKER, BETH A (PHD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:A
Last Name:DOROGUSKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 PARK RD
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-2216
Mailing Address - Country:US
Mailing Address - Phone:973-763-8375
Mailing Address - Fax:973-763-4419
Practice Address - Street 1:1 LENOX PLACE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040
Practice Address - Country:US
Practice Address - Phone:973-763-8357
Practice Address - Fax:973-763-4419
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ03595103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical