Provider Demographics
NPI:1982740072
Name:JURISH, SUSAN E (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:E
Last Name:JURISH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 GORDONS CORNER RD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3356
Mailing Address - Country:US
Mailing Address - Phone:732-446-3993
Mailing Address - Fax:732-446-6287
Practice Address - Street 1:225 GORDONS CORNER RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-3356
Practice Address - Country:US
Practice Address - Phone:732-446-3993
Practice Address - Fax:732-446-6287
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00217300103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical