Provider Demographics
NPI:1669532495
Name:SUSSMAN, LAURIE ANNE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:ANNE
Last Name:SUSSMAN
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 1:21 LIBERTY KNLS
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-1363
Mailing Address - Country:US
Mailing Address - Phone:732-741-3377
Mailing Address - Fax:732-741-4955
Practice Address - Street 1:9 PROFESSIONAL CIR
Practice Address - Street 2:UNIT 208
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-2426
Practice Address - Country:US
Practice Address - Phone:732-431-3308
Practice Address - Fax:732-431-3717
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC001665001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical