Provider Demographics
NPI:1265512479
Name:MOHR, SUSAN (LCSW)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:MOHR
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 1:219 TAYLORS MILLS RD
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3255
Mailing Address - Country:US
Mailing Address - Phone:908-415-2042
Mailing Address - Fax:908-415-2042
Practice Address - Street 1:219 TAYLORS MILLS RD
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-3255
Practice Address - Country:US
Practice Address - Phone:908-415-2042
Practice Address - Fax:908-415-2042
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ47935103T00000X
FLSW146271041C0700X
NJ44SC047935001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ800008780Medicaid