Provider Demographics
NPI:1427612944
Name:WOLF, SUSAN SUTTON (LPC)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:SUTTON
Last Name:WOLF
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 1:515 SHACKAMAXON DR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-3303
Mailing Address - Country:US
Mailing Address - Phone:973-452-2397
Mailing Address - Fax:
Practice Address - Street 1:515 SHACKAMAXON DR
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-3303
Practice Address - Country:US
Practice Address - Phone:908-789-7427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-30
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00716700101YP2500X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ37AC00366300OtherNJ LAC LICENSE