Provider Demographics
NPI:1699591677
Name:MRSIC, SUSAN (LSW)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:MRSIC
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 JERSEY AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:NJ
Mailing Address - Zip Code:07022-1204
Mailing Address - Country:US
Mailing Address - Phone:201-776-4139
Mailing Address - Fax:201-333-4211
Practice Address - Street 1:249 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-1423
Practice Address - Country:US
Practice Address - Phone:201-798-9921
Practice Address - Fax:201-333-4211
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL062475001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical