Provider Demographics
NPI:1932277241
Name:DRAKE, SUZANNE (PHD APRN BC)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:
Last Name:DRAKE
Suffix:
Gender:F
Credentials:PHD APRN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 D LAKE STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-1243
Mailing Address - Country:US
Mailing Address - Phone:201-818-9401
Mailing Address - Fax:908-754-5907
Practice Address - Street 1:400 D LAKE STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1243
Practice Address - Country:US
Practice Address - Phone:201-818-9401
Practice Address - Fax:908-754-5907
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NC06945900364SP0809X
NY217409364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult