Provider Demographics
NPI:1861041089
Name:SMEDRESMAN, SUSANNAH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SUSANNAH
Middle Name:
Last Name:SMEDRESMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 HARRINGTON AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624-1911
Mailing Address - Country:US
Mailing Address - Phone:551-236-3622
Mailing Address - Fax:
Practice Address - Street 1:317 HARRINGTON AVE STE 8
Practice Address - Street 2:
Practice Address - City:CLOSTER
Practice Address - State:NJ
Practice Address - Zip Code:07624-1911
Practice Address - Country:US
Practice Address - Phone:551-236-3622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022239103TC0700X
NJ35SI00612500103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical