Provider Demographics
NPI:1609953637
Name:MASLUK, SUSAN (MSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MASLUK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MAPLE AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1732
Mailing Address - Country:US
Mailing Address - Phone:732-747-1331
Mailing Address - Fax:732-747-7878
Practice Address - Street 1:200 MAPLE AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1732
Practice Address - Country:US
Practice Address - Phone:732-747-1331
Practice Address - Fax:732-747-7878
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC014493001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMA193619Medicare ID - Type Unspecified