Provider Demographics
NPI:1356456925
Name:SIEGELTUCH, SUSAN D (LCSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:D
Last Name:SIEGELTUCH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:D
Other - Last Name:WITKIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:70 PARKER AVENUE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-1746
Mailing Address - Country:US
Mailing Address - Phone:973-378-8635
Mailing Address - Fax:
Practice Address - Street 1:70 PARKER AVENUE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-1746
Practice Address - Country:US
Practice Address - Phone:973-378-8635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC001349001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical