Doctor Name: | SUZANNE PORRECA |
NPI Number: | 1710135066 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PHD |
License Number: | 3SI100458400 |
Business Practice Address: | 2500 English Creek Ave Bldg E Egg Harbor Twp, NJ - 082345549 |
Business Phone Number: | 6092728580 |
Business Fax Number: | 6092728707 |
Mailing Address: | Po Box 1086, PLEASANTVILLE |
State: | NJ |
Postal Code: | 082326086 |
Phone Number: | 6092728580 |
Fax Number: | 6092728707 |
NPI Enumeration Date: | 08/28/2008 |
NPI Last Update Date: | 10/13/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 3SI100458400 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |