Provider Demographics
NPI:1700200177
Name:SUTIN, EMILY (MT-BC)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:
Last Name:SUTIN
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 FANSHAWE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-2608
Mailing Address - Country:US
Mailing Address - Phone:267-391-6461
Mailing Address - Fax:
Practice Address - Street 1:10 UNION ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-2416
Practice Address - Country:US
Practice Address - Phone:609-654-0060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA08592225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist