Provider Demographics
NPI:1437216215
Name:HEGUY, SUSANNAH JANE (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSANNAH
Middle Name:JANE
Last Name:HEGUY
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 1:44 COBBLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-2037
Mailing Address - Country:US
Mailing Address - Phone:973-422-1603
Mailing Address - Fax:973-422-1603
Practice Address - Street 1:17-07 ROMAINE STREET
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410
Practice Address - Country:US
Practice Address - Phone:201-797-2660
Practice Address - Fax:201-797-4895
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052260001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0020176Medicaid
NJ44SC05226000OtherL.C.S.W