Provider Demographics
NPI:1447542154
Name:WHITE, SUSAN R (MA, LPC, CEAP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:WHITE
Suffix:
Gender:F
Credentials:MA, LPC, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 E MAIN ST STE 185
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-4639
Mailing Address - Country:US
Mailing Address - Phone:856-887-1422
Mailing Address - Fax:
Practice Address - Street 1:1 CHESTNUT HILL PLZ STE 1219
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2761
Practice Address - Country:US
Practice Address - Phone:856-887-1422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC0048200101YP2500X
DEPC-0000730101YP2500X
MDLC5501101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional