Provider Demographics
NPI:1902949894
Name:MUSETTO, ANDREW P (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:P
Last Name:MUSETTO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 GROVE ST
Mailing Address - Street 2:C
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-1232
Mailing Address - Country:US
Mailing Address - Phone:856-428-6640
Mailing Address - Fax:856-428-9185
Practice Address - Street 1:49 GROVE ST
Practice Address - Street 2:C
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-1232
Practice Address - Country:US
Practice Address - Phone:856-428-6640
Practice Address - Fax:856-428-9185
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00102900103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF 10506OtherFIRST OPTION
NJJO 18078OtherTRICARE CHAMPUS
NJJO 18078OtherTRICARE CHAMPUS