Active NPI
Susan Ann Adubato, PHD
- Clinical Child & Adolescent Psychologist
- Newark, NJ
National Provider Identifier
1730224601
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- 35SI00226100
- Practice address
- 30 Bergen St
Admc 1608
Newark, NJ 07107-3000 - Phone
- (973) 972-7717
- Fax
- (973) 972-6556
- NPI assigned
- Feb 20, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | 35SI00226100 | NJ | Primary |
Addresses
Primary practice location
30 Bergen St
Admc 1608
Newark, NJ 07107-3000
Mailing address
30 Bergen St
Admc 12 1205
Newark, NJ 07107-3000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1574701 | Medicaid | NJ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35SI00226100 | NJ | MD | Clinical Child & Adolescent Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171929600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1250208000000",
"number": "1730224601",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 BERGEN ST",
"address_2": "ADMC 12 1205",
"city": "NEWARK",
"state": "NJ",
"postal_code": "071073000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 BERGEN ST",
"address_2": "ADMC 1608",
"city": "NEWARK",
"state": "NJ",
"postal_code": "071073000",
"telephone_number": "973-972-7717",
"fax_number": "973-972-6556"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ADUBATO",
"first_name": "SUSAN",
"middle_name": "ANN",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-20",
"last_updated": "2009-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "NJ",
"license": "35SI00226100",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1574701",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Newark, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.