Provider Demographics
NPI:1831797976
Name:WALKER, SUSAN M (PHD, CGP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:WALKER
Suffix:
Gender:F
Credentials:PHD, CGP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SUSAN M WALKER, PHD
Mailing Address - Street 1:63 BALD EAGLE RD
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-2812
Mailing Address - Country:US
Mailing Address - Phone:610-844-2685
Mailing Address - Fax:
Practice Address - Street 1:88 PARK ST
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-5915
Practice Address - Country:US
Practice Address - Phone:610-844-2685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46300103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling