Provider Demographics
NPI:1538106539
Name:MARON, SUSAN MARIA (RN,NCC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARIA
Last Name:MARON
Suffix:
Gender:F
Credentials:RN,NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SAGE RD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-2626
Mailing Address - Country:US
Mailing Address - Phone:732-279-0491
Mailing Address - Fax:732-279-0497
Practice Address - Street 1:254 BRICK BLVD
Practice Address - Street 2:SUITE 11
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-7170
Practice Address - Country:US
Practice Address - Phone:732-262-8300
Practice Address - Fax:732-262-8301
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00300400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ200913782OtherTAXPAYER IDENTIFICATION N