Provider Demographics
NPI:1881155083
Name:FELDMAN, SUZANNE (LSW)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:FELDMAN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:FELDMAN-LEVY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:3 SOMERSET LN
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-2419
Mailing Address - Country:US
Mailing Address - Phone:201-248-7200
Mailing Address - Fax:
Practice Address - Street 1:3 SOMERSET LN
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-2419
Practice Address - Country:US
Practice Address - Phone:201-248-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-29
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06316800104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ020592109OtherE.I.N.