Healthcare Provider Details

I. General information

NPI: 1568270981
Provider Name (Legal Business Name): SUSAN DURANT SOCIAL WORKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 12/19/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 WESTFIELD AVE
ELIZABETH NJ
07208-1398
US

IV. Provider business mailing address

655 WESTFIELD AVE
ELIZABETH NJ
07208-1398
US

V. Phone/Fax

Practice location:
  • Phone: 908-352-8375
  • Fax: 908-352-8858
Mailing address:
  • Phone: 908-352-8375
  • Fax: 908-352-8858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SW00736300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: