Provider Demographics
NPI:1679727788
Name:BILLETER, SUSANNE E (MDIV, NCPSYA)
Entity Type:Individual
Prefix:MRS
First Name:SUSANNE
Middle Name:E
Last Name:BILLETER
Suffix:
Gender:F
Credentials:MDIV, NCPSYA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-1404
Mailing Address - Country:US
Mailing Address - Phone:718-986-6566
Mailing Address - Fax:
Practice Address - Street 1:1014 BIRCH ST
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-1404
Practice Address - Country:US
Practice Address - Phone:718-986-6566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2024-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP000846102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00244720Medicaid
NY00244720Medicaid