Provider Demographics
NPI:1790735645
Name:KASPER, SUSAN K (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:K
Last Name:KASPER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 273
Mailing Address - Street 2:
Mailing Address - City:BUDD LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07828-0273
Mailing Address - Country:US
Mailing Address - Phone:908-684-5600
Mailing Address - Fax:908-684-5601
Practice Address - Street 1:110A MOUNTAIN CT
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2317
Practice Address - Country:US
Practice Address - Phone:908-684-5600
Practice Address - Fax:908-684-5601
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI0001972103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ455359Medicare ID - Type Unspecified