Provider Demographics
NPI:1316363138
Name:SUSAN A FISHLOCK LCSW PA
Entity Type:Organization
Organization Name:SUSAN A FISHLOCK LCSW PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ LCSW
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:862-221-1110
Mailing Address - Street 1:59 BEAVERBROOK RD STE 201F
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07035-1789
Mailing Address - Country:US
Mailing Address - Phone:862-221-1110
Mailing Address - Fax:
Practice Address - Street 1:59 BEAVERBROOK RD STE 201F
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:NJ
Practice Address - Zip Code:07035-1789
Practice Address - Country:US
Practice Address - Phone:862-221-1110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054795001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty