Provider Demographics
NPI:1417494550
Name:HARRISON, SUSAN (MA, LAC, NCC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
Credentials:MA, LAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 THIRD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-1369
Mailing Address - Country:US
Mailing Address - Phone:609-434-2898
Mailing Address - Fax:
Practice Address - Street 1:33 THIRD ST STE 101
Practice Address - Street 2:
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505-1369
Practice Address - Country:US
Practice Address - Phone:609-434-2898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-27
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist