Provider Demographics
NPI:1689923930
Name:GAIA, SUSANA P (MA, LMHC, LPC)
Entity Type:Individual
Prefix:MS
First Name:SUSANA
Middle Name:P
Last Name:GAIA
Suffix:
Gender:F
Credentials:MA, LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5808 WASHINGTON ST APT 305
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-1583
Mailing Address - Country:US
Mailing Address - Phone:917-459-2463
Mailing Address - Fax:
Practice Address - Street 1:290 FERRY ST BSMT A2
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-3475
Practice Address - Country:US
Practice Address - Phone:917-459-2463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101YP2500X
NY007828-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional