Provider Demographics
NPI:1780666909
Name:MILLNER, SUSAN M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:M
Last Name:MILLNER
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 1:3648 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18933-9712
Mailing Address - Country:US
Mailing Address - Phone:732-794-0580
Mailing Address - Fax:
Practice Address - Street 1:361 ROUTE 31 STE 1501
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-3392
Practice Address - Country:US
Practice Address - Phone:732-545-3020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC001589001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ667336Medicare ID - Type Unspecified