Provider Demographics
NPI:1952479990
Name:FUTTERMAN, CHERYL SUSAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:SUSAN
Last Name:FUTTERMAN
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 1:74 COURTER AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-2820
Mailing Address - Country:US
Mailing Address - Phone:973-378-2440
Mailing Address - Fax:973-912-0103
Practice Address - Street 1:407 ESSEX ST
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1316
Practice Address - Country:US
Practice Address - Phone:973-912-0102
Practice Address - Fax:973-912-0103
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2740103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ753976Medicare ID - Type Unspecified