Provider Demographics
NPI:1265573000
Name:SUSAN ELAINE ALEXANDER, PH.D.,LLC
Entity type:Organization
Organization Name:SUSAN ELAINE ALEXANDER, PH.D.,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER,SOLE PROPRIETER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:908-788-7889
Mailing Address - Street 1:134 MAIN ST
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-1652
Mailing Address - Country:US
Mailing Address - Phone:908-788-7889
Mailing Address - Fax:908-788-0840
Practice Address - Street 1:134 MAIN ST
Practice Address - Street 2:SUITE 2C
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-1652
Practice Address - Country:US
Practice Address - Phone:908-788-7889
Practice Address - Fax:908-788-0840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI03384261QM0850X
NJSI00384261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Not Answered261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ952730Medicare ID - Type Unspecified