Provider Demographics
NPI:1306874698
Name:SUSAN, PAULA (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:PAULA
Middle Name:
Last Name:SUSAN
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 1:9 FULTON DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-4510
Mailing Address - Country:US
Mailing Address - Phone:856-396-0900
Mailing Address - Fax:856-396-0901
Practice Address - Street 1:9 FULTON DR
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-4510
Practice Address - Country:US
Practice Address - Phone:856-396-0900
Practice Address - Fax:856-396-0901
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC00066174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ704238Medicare ID - Type UnspecifiedSOCIAL WORKER