Provider Demographics
NPI:1235414400
Name:FARLEY, SUSAN M (MA, LPC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:FARLEY
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4981 MCDERMOTT RD
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:PA
Mailing Address - Zip Code:18013-4715
Mailing Address - Country:US
Mailing Address - Phone:908-510-3118
Mailing Address - Fax:
Practice Address - Street 1:114 S 2ND ST
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1806
Practice Address - Country:US
Practice Address - Phone:908-510-3118
Practice Address - Fax:908-290-5215
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NJ37PC00513800101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor