Provider Demographics
NPI:1982379293
Name:KUSHNER, SUSAN (LPC, RYT-200)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:KUSHNER
Suffix:
Gender:F
Credentials:LPC, RYT-200
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 W SHORE DR
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-2009
Mailing Address - Country:US
Mailing Address - Phone:917-703-6449
Mailing Address - Fax:
Practice Address - Street 1:81 W SHORE DR
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-2009
Practice Address - Country:US
Practice Address - Phone:917-703-6449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PCOO583700101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health