Provider Demographics
NPI:1659494920
Name:HERSCHMAN, SUSAN GAIL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:GAIL
Last Name:HERSCHMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W HANOVER AVE
Mailing Address - Street 2:203
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-4222
Mailing Address - Country:US
Mailing Address - Phone:973-983-8321
Mailing Address - Fax:973-983-2680
Practice Address - Street 1:2 W HANOVER AVE
Practice Address - Street 2:203
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-4222
Practice Address - Country:US
Practice Address - Phone:973-983-8321
Practice Address - Fax:973-983-2680
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI 03190101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health