Provider Demographics
NPI:1386665776
Name:ALEXANDER, SUSAN E (PHD, LLC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:E
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:PHD, LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 ROUTE 31
Mailing Address - Street 2:SUITE 704
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-5796
Mailing Address - Country:US
Mailing Address - Phone:908-788-7889
Mailing Address - Fax:908-788-7889
Practice Address - Street 1:361 ROUTE 31
Practice Address - Street 2:SUITE 704
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-5796
Practice Address - Country:US
Practice Address - Phone:908-788-7889
Practice Address - Fax:908-788-7889
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI03384103TC0700X, 103T00000X, 103TA0700X, 103TB0200X, 103TC2200X, 103TH0004X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ952730Medicare ID - Type Unspecified