Provider Demographics
NPI:1770854846
Name:FISHLOCK, SUSAN (LCSW, MSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:FISHLOCK
Suffix:
Gender:F
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:BOONTON TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-9237
Mailing Address - Country:US
Mailing Address - Phone:973-896-6919
Mailing Address - Fax:
Practice Address - Street 1:12 VALLEY RD
Practice Address - Street 2:
Practice Address - City:BOONTON TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07005-9237
Practice Address - Country:US
Practice Address - Phone:973-896-6919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-22
Last Update Date:2012-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054795001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical