Provider Demographics
NPI:1659593382
Name:FALLON, SUE (MS, LPC)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:FALLON
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 MALLARD CT
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-5041
Mailing Address - Country:US
Mailing Address - Phone:201-227-1580
Mailing Address - Fax:201-227-1583
Practice Address - Street 1:14 MALLARD CT
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-5041
Practice Address - Country:US
Practice Address - Phone:201-227-1580
Practice Address - Fax:201-227-1583
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ78931101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health