Provider Demographics
NPI:1437265428
Name:DAURIA, SUSAN CLARK (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:CLARK
Last Name:DAURIA
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 1:121 SHELLEY DR
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-2530
Mailing Address - Country:US
Mailing Address - Phone:908-813-8820
Mailing Address - Fax:908-813-2715
Practice Address - Street 1:121 SHELLEY DR
Practice Address - Street 2:SUITE 2F
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2530
Practice Address - Country:US
Practice Address - Phone:908-813-8820
Practice Address - Fax:908-813-2715
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC028311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ660806Medicare UPIN