1639590144 NPI number — DR. SUZANNE MARIE GATTUSO PSY.D.

Table of content: DR. SUZANNE MARIE GATTUSO PSY.D. (NPI 1639590144)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639590144 NPI number — DR. SUZANNE MARIE GATTUSO PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GATTUSO
Provider First Name:
SUZANNE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639590144
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1378 HENDERSONVILLE RD STE F
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28803-1900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-280-3458
Provider Business Mailing Address Fax Number:
828-277-5284

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1378 HENDERSONVILLE RD
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
ASHEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28803-1957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-277-5281
Provider Business Practice Location Address Fax Number:
828-277-5284
Provider Enumeration Date:
12/31/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  1983 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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