Organization
DATERRA PSYCHOTHERAPY AND WELLNESS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSANA P GAIA MA, LMHC, LPC (S-CORP OWNER/PSYCHOTHERAPIST)
(917) 622-3749
Entity
Organization
Contact information
Practice address
290 FERRY ST BSMT A2, NEWARK, NJ 07105-3475
(917) 459-2463
Mailing address
5808 WASHINGTON ST APT 305, WEST NEW YORK, NJ 07093-1583
(917) 622-3749
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
007828-1
NY
101YP2500X
Professional Counselor
Primary
37PC00598200
NJ
Other
Enumeration date
10/26/2017
Last updated
10/26/2017
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