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NPI Code Detail

MEDICARE: SUSAN MARION RICE LAC

MEDICARE: SUSAN MARION RICE LAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor37AC00505100NJ

General Provider Information

NPI Number : 1174190276
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN MARION RICE LAC
Provider Business Mailing Address
First Line : 6 VAN GOGH LN
Second Line :
City : AIRMONT
State : NY
Zip : 10901-7717
Country : US
Telephone Number : 845-553-5530
Fax Number :
Provider Business Practice Location Address
First Line : 545 ISLAND RD STE 2B
Second Line :
City : RAMSEY
State : NJ
Zip : 07446-2822
Country : US
Telephone Number : 201-995-1004
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2021
Last Update Date : 06/07/2021

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Directions to “ SUSAN MARION RICE LAC” Practice Location

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