Provider Demographics
NPI:1417229444
Name:TAYLOR, SUSAN (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:TAYLOR
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 1:52 HYERS ST STE 3
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-7465
Mailing Address - Country:US
Mailing Address - Phone:327-281-2060
Mailing Address - Fax:327-281-6969
Practice Address - Street 1:52 HYERS ST STE 3
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-7465
Practice Address - Country:US
Practice Address - Phone:732-281-2060
Practice Address - Fax:732-281-6969
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00679000101YP2500X
NJ37PC00553000101YP2500X
NJ44SC058491001041C0700X
NJBS11292792084P0800X
NJ44C055739001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty