Provider Demographics
NPI:1891990107
Name:MOCK, SUSAN Z (LPC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:Z
Last Name:MOCK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 COOPER ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-4646
Mailing Address - Country:US
Mailing Address - Phone:856-853-6100
Mailing Address - Fax:856-853-0919
Practice Address - Street 1:41 COOPER ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-4646
Practice Address - Country:US
Practice Address - Phone:856-853-6100
Practice Address - Fax:856-853-0919
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00223600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0025453Medicaid