Provider Demographics
NPI:1154765329
Name:WALDEN, SUSAN (LMFT)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:WALDEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:GREENBERG
Other - Last Name:WALDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT, JD
Mailing Address - Street 1:340 HIGHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LEONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07605-2022
Mailing Address - Country:US
Mailing Address - Phone:201-981-4560
Mailing Address - Fax:
Practice Address - Street 1:633 PALISADE AVE
Practice Address - Street 2:1A
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-3084
Practice Address - Country:US
Practice Address - Phone:201-981-4560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37F100174100106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist