Provider Demographics
NPI:1386729283
Name:LEAHY-MULROE, SUSAN (LCSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:LEAHY-MULROE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:581 BERGEN BLVD
Mailing Address - Street 2:SUITE #6
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-2030
Mailing Address - Country:US
Mailing Address - Phone:201-313-9155
Mailing Address - Fax:201-765-9470
Practice Address - Street 1:581 BERGEN BLVD
Practice Address - Street 2:SUITE #6
Practice Address - City:RIDGEFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07657-2030
Practice Address - Country:US
Practice Address - Phone:201-313-9155
Practice Address - Fax:201-765-9470
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC043996001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical