Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 35SIO00563500 | NJ |
N | 103T00000X | Psychologist | 35SIO00563500 | NJ |
N | 102L00000X | Psychologist | 35SI00263500 | NJ |
N | 103T00000X | Psychologist | 35SI00263500 | NJ |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 35SI00263500 | NJ |
N | 103G00000X | Clinical Psychologist | 35SI00263500 | NJ |
N | 103TC0700X | Clinical Psychologist | 35SI00263500 | NJ |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 35SI00263500 | NJ |
N | 103TH0100X | Health Service | 35SI00263500 | NJ |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 26NJ00080100 | NJ |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 26NJ00080100 | NJ |
N | 363LP2300X | Nurse Practitioner - Primary Care | 26NJ00080100 | NJ |
N | 363LW0102X | Nurse Practitioner - Women's Health | 26NJ00080100 | NJ |
NPI | 1205936093 |
---|---|
Provider Name | Dr. Vanessa Gourdine |
First Address | Hackensack, NJ 07601-1262 |
Second Address | Hackensack, NJ 07601-1262 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 08/11/2013 |