Provider Demographics
NPI:1760452833
Name:HASKELL, SUSAN B (MSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:B
Last Name:HASKELL
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 1:4 PEABODY CT
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-6469
Mailing Address - Country:US
Mailing Address - Phone:201-287-0339
Mailing Address - Fax:201-836-3801
Practice Address - Street 1:1567 PALISADE AVE
Practice Address - Street 2:2C
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6923
Practice Address - Country:US
Practice Address - Phone:201-592-7239
Practice Address - Fax:201-836-3801
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC000160001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ640823Medicare ID - Type Unspecified