Provider Demographics
NPI:1649948381
Name:NUSSDORFER, EMILY E (LPC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:E
Last Name:NUSSDORFER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6814 QUINCY ST APT 3F
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-2670
Mailing Address - Country:US
Mailing Address - Phone:610-322-6864
Mailing Address - Fax:
Practice Address - Street 1:6814 QUINCY ST APT 3F
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-2670
Practice Address - Country:US
Practice Address - Phone:610-322-6864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC013602101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor