Healthcare Provider Details

I. General information

NPI: 1619077872
Provider Name (Legal Business Name): SUSAN BURRIS MADEIRA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 HAMILTON AVE FAMILY GUIDANCE CENTER CORPORATION
HAMILTON NJ
08619-3007
US

IV. Provider business mailing address

38 CROWN TER
YARDLEY PA
19067-7346
US

V. Phone/Fax

Practice location:
  • Phone: 609-587-7044
  • Fax: 609-587-6765
Mailing address:
  • Phone: 215-736-9143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC00183300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: