Provider Demographics
NPI:1104317635
Name:STEPHENS, SUSAN (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 N JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-4302
Mailing Address - Country:US
Mailing Address - Phone:908-872-3183
Mailing Address - Fax:732-235-6462
Practice Address - Street 1:195 LITTLE ALBANY ST # 1179
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901
Practice Address - Country:US
Practice Address - Phone:732-235-8867
Practice Address - Fax:732-235-6462
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC013021001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical