Provider Demographics
NPI:1871908046
Name:ERNST, SUZANNE V (PSYD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:V
Last Name:ERNST
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 BORTONS LANDING RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3011
Mailing Address - Country:US
Mailing Address - Phone:856-780-6293
Mailing Address - Fax:
Practice Address - Street 1:128 BORTONS LANDING RD
Practice Address - Street 2:SUITE 2
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3011
Practice Address - Country:US
Practice Address - Phone:856-780-6293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ143-010103T00000X, 103TB0200X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral