Provider Demographics
NPI:1265825616
Name:RIDDLE, SUSAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 BECKETT RD
Mailing Address - Street 2:SUITE 105-106
Mailing Address - City:SWEDESBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-1547
Mailing Address - Country:US
Mailing Address - Phone:856-467-6687
Mailing Address - Fax:
Practice Address - Street 1:545 BECKETT RD
Practice Address - Street 2:SUITE 105-106
Practice Address - City:SWEDESBORO
Practice Address - State:NJ
Practice Address - Zip Code:08085-1547
Practice Address - Country:US
Practice Address - Phone:856-467-6687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC010236001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical