Provider Demographics
NPI:1467987834
Name:JAREK, SUSAN L (PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:L
Last Name:JAREK
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:L
Other - Last Name:GILMARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6865
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-5231
Mailing Address - Country:US
Mailing Address - Phone:757-310-8167
Mailing Address - Fax:
Practice Address - Street 1:11815 FOUNTAIN WAY STE 300
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4448
Practice Address - Country:US
Practice Address - Phone:757-603-3986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH061597-21163WP0808X
NH061597-23363LP0808X
VA0024175618363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health