Provider Demographics
NPI:1710102355
Name:HODOS, SUSAN J (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:HODOS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 N MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2307
Mailing Address - Country:US
Mailing Address - Phone:973-744-9784
Mailing Address - Fax:973-744-1215
Practice Address - Street 1:212 N MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2307
Practice Address - Country:US
Practice Address - Phone:973-744-9784
Practice Address - Fax:973-744-1215
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC003915001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ694717Medicare ID - Type Unspecified