Provider Demographics
NPI:1881318368
Name:VANDUSEN, ELIZABETH DAVIE (MPS, ATR-BC, LPAT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DAVIE
Last Name:VANDUSEN
Suffix:
Gender:F
Credentials:MPS, ATR-BC, LPAT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:DAVIE
Other - Last Name:VANDUSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:534 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-1339
Mailing Address - Country:US
Mailing Address - Phone:917-710-2278
Mailing Address - Fax:
Practice Address - Street 1:550 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-1168
Practice Address - Country:US
Practice Address - Phone:917-710-2278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ16LP00009200106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty