Provider Demographics
NPI:1760649792
Name:MINTZ, SUSAN C (LCSW MA)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:C
Last Name:MINTZ
Suffix:
Gender:F
Credentials:LCSW MA
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:C
Other - Last Name:BERGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:160 LINCOLN STREET
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631
Mailing Address - Country:US
Mailing Address - Phone:201-916-6000
Mailing Address - Fax:201-567-5221
Practice Address - Street 1:160 LINCOLN STREET
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631
Practice Address - Country:US
Practice Address - Phone:201-916-6000
Practice Address - Fax:201-567-5221
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0751871041C0700X
NJ44SL008744001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical