Provider Demographics
NPI:1568270981
Name:DURANT, SUSAN (SOCIAL WORKER)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:DURANT
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 WESTFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-1398
Mailing Address - Country:US
Mailing Address - Phone:908-352-8375
Mailing Address - Fax:908-352-8858
Practice Address - Street 1:655 WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-1398
Practice Address - Country:US
Practice Address - Phone:908-352-8375
Practice Address - Fax:908-352-8858
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SW00736300104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty