Healthcare Provider Details

I. General information

NPI: 1033792312
Provider Name (Legal Business Name): SUSAN CIOFALO LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSAN BOWEN

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 05/04/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 TILTON RD
NORTHFIELD NJ
08225-1217
US

IV. Provider business mailing address

6 HAVERFORD RD
SOMERS POINT NJ
08244-1522
US

V. Phone/Fax

Practice location:
  • Phone: 609-667-7823
  • Fax:
Mailing address:
  • Phone: 609-992-5339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number44SL06216900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL06216900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: