Active NPI
Susannah Smedresman, PSY.D.
- Clinical Psychologist
- Closter, NJ
National Provider Identifier
1861041089
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 35SI00612500
- Practice address
- 317 Harrington Ave Ste 8
Closter, NJ 07624-1911 - Phone
- (551) 236-3622
- NPI assigned
- Sep 10, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 022239 | NY | |
| Clinical Psychologist | 103TC0700X | 35SI00612500 | NJ | Primary |
Addresses
Primary practice location
317 Harrington Ave Ste 8
Closter, NJ 07624-1911
Mailing address
317 Harrington Ave Ste 8
Closter, NJ 07624-1911
Phone (551) 236-3622
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35SI00612500 | NJ | MD | Clinical Psychologist |
| 022239 | NY | MD | Physical Rehabilitation Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1568073600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1568073600000",
"number": "1861041089",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "317 HARRINGTON AVE STE 8",
"city": "CLOSTER",
"state": "NJ",
"postal_code": "076241911",
"telephone_number": "551-236-3622"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "317 HARRINGTON AVE STE 8",
"city": "CLOSTER",
"state": "NJ",
"postal_code": "076241911",
"telephone_number": "551-236-3622"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMEDRESMAN",
"first_name": "SUSANNAH",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-09-10",
"last_updated": "2019-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "022239",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NJ",
"license": "35SI00612500",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Closter, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.