Provider Demographics
NPI:1386889160
Name:BROWN, SUSAN V (CMT)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:V
Last Name:BROWN
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1346 ROUTE 739
Mailing Address - Street 2:
Mailing Address - City:DINGMANS FERRY
Mailing Address - State:PA
Mailing Address - Zip Code:18328-3423
Mailing Address - Country:US
Mailing Address - Phone:570-686-4300
Mailing Address - Fax:579-686-4302
Practice Address - Street 1:1346 ROUTE 739
Practice Address - Street 2:
Practice Address - City:DINGMANS FERRY
Practice Address - State:PA
Practice Address - Zip Code:18328-3423
Practice Address - Country:US
Practice Address - Phone:570-686-4300
Practice Address - Fax:579-686-4302
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26BT00059900225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26BT00059900OtherNJ BOARD OF COSMOTOLOGY ATTORNEY GENERAL OFFICE