Provider Demographics
NPI:1124164819
Name:SULZMAN, ELOISE JAMISON (MSW)
Entity type:Individual
Prefix:MS
First Name:ELOISE
Middle Name:JAMISON
Last Name:SULZMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:ELOISE
Other - Middle Name:CLAIRE
Other - Last Name:JAMISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:1868 GREENTREE ROAD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-2031
Mailing Address - Country:US
Mailing Address - Phone:856-424-4408
Mailing Address - Fax:856-424-9164
Practice Address - Street 1:1868 GREENTREE ROAD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-2031
Practice Address - Country:US
Practice Address - Phone:856-424-4408
Practice Address - Fax:856-424-9164
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC008674001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0040509Medicaid
NJ0040509Medicaid