Provider Demographics
NPI:1194969683
Name:GORMAN, SUSAN (LPC)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:GORMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 WHIPPOORWILL LN
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-4222
Mailing Address - Country:US
Mailing Address - Phone:201-874-8662
Mailing Address - Fax:
Practice Address - Street 1:400 MORRIS AVE
Practice Address - Street 2:SUITE 214
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-1362
Practice Address - Country:US
Practice Address - Phone:201-874-8662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00390700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4138601Medicaid
NJ4138601Medicaid