Provider Demographics
NPI:1457483349
Name:EDWARDS, SUSAN JANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:JANE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:JANE
Other - Last Name:STABNAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 268
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08553-0268
Mailing Address - Country:US
Mailing Address - Phone:609-216-1910
Mailing Address - Fax:
Practice Address - Street 1:2301 E EVESHAM RD STE 206
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4504
Practice Address - Country:US
Practice Address - Phone:609-216-1910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016430103T00000X
NJ35SI00265400103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist