Healthcare Provider Details

I. General information

NPI: 1184654998
Provider Name (Legal Business Name): SUSAN COHEN ESQUILIN PSYCHOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSAN COHEN ESQUILIN PH.D.

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 PARK ST
MONTCLAIR NJ
07042-3440
US

IV. Provider business mailing address

38 PARK ST
MONTCLAIR NJ
07042-3440
US

V. Phone/Fax

Practice location:
  • Phone: 973-744-1720
  • Fax: 866-371-4675
Mailing address:
  • Phone: 973-744-1720
  • Fax: 866-371-4675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number35SI00174800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: