Provider Demographics
NPI:1467892083
Name:TALTY, SUSAN P (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:P
Last Name:TALTY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:P
Other - Last Name:TALTY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:746 HIGHWAY 34
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-6685
Mailing Address - Country:US
Mailing Address - Phone:732-264-8878
Mailing Address - Fax:732-566-7727
Practice Address - Street 1:191 HIGHWAY 37 W
Practice Address - Street 2:SUITE 2
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8061
Practice Address - Country:US
Practice Address - Phone:732-264-8878
Practice Address - Fax:732-566-7727
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC008457001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical