Provider Demographics
NPI:1104660604
Name:WARD, SUSAN L (NBC-HWC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:WARD
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3465
Mailing Address - Street 2:
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-3465
Mailing Address - Country:US
Mailing Address - Phone:973-975-4299
Mailing Address - Fax:
Practice Address - Street 1:54 CHRISTOPHER ST # 7042
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-4016
Practice Address - Country:US
Practice Address - Phone:973-975-4299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach