Healthcare Provider Details

I. General information

NPI: 1285762757
Provider Name (Legal Business Name): GERILYN ANN SUSCHKE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 QUAKERBRIDGE RD
HAMILTON NJ
08619-1208
US

IV. Provider business mailing address

1 NALBONE CT
TRENTON NJ
08620-9777
US

V. Phone/Fax

Practice location:
  • Phone: 609-403-6190
  • Fax: 609-403-6191
Mailing address:
  • Phone: 609-504-9588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC00297600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00297600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: