Susan Buonocore, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

017106 Issued in NY

Practice address

1 Hope St
Montvale, NJ 07645-1342

Phone

(201) 483-8015

NPI assigned

Nov 5, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Susan Russello Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1446681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1446681600000",
    "number": "1891168274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 HOPE ST",
            "city": "MONTVALE",
            "state": "NJ",
            "postal_code": "076451342",
            "telephone_number": "201-483-8015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 HOPE ST",
            "city": "MONTVALE",
            "state": "NJ",
            "postal_code": "076451342",
            "telephone_number": "201-483-8015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUONOCORE",
        "first_name": "SUSAN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-05",
        "last_updated": "2015-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "017106",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "RUSSELLO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Brendan Raymond Bolduc, PT, DPT, CSCS
• Erline Boyer, LMT
• Thomasina Breen, LAC
• Mahitha Reddy Brown, DPT, ATC, NCPT
• Building Butterflies LLC
• Teresa Bustamante, NP-C
• Dhielan Bungay Bustos, DPT
• Kellie Jean Carpenter
• Deirdre B. Casey, MSN, RN, AGACNP-BC
• Patricia A Cavanna, RNFA

• Clinical Psychologist in Montvale, NJ
• Providers in Montvale, NJ by specialty
• Clinical Psychologist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.