Provider Demographics
NPI:1992166755
Name:MEKLUNE, SUSAN
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:MEKLUNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 ROUTE 18 STE 102
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-1913
Mailing Address - Country:US
Mailing Address - Phone:732-770-0433
Mailing Address - Fax:
Practice Address - Street 1:223 ROUTE 18 STE 102
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-1913
Practice Address - Country:US
Practice Address - Phone:732-770-0433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00187600106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist