Provider Demographics
NPI:1407147796
Name:GERSTLEY, SUSAN DALE (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DALE
Last Name:GERSTLEY
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 1:10 STONE RDG
Mailing Address - Street 2:
Mailing Address - City:WOODCLIFF LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07677-7920
Mailing Address - Country:US
Mailing Address - Phone:201-580-1449
Mailing Address - Fax:
Practice Address - Street 1:75 N MAPLE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3247
Practice Address - Country:US
Practice Address - Phone:201-580-1449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-21
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054611001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical