Healthcare Provider Details

I. General information

NPI: 1902008329
Provider Name (Legal Business Name): SUSAN MURIN LCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 ROOSEVELT AVE # 119
PLAINFIELD NJ
07060-1331
US

IV. Provider business mailing address

33 COLDEVIN RD
CLARK NJ
07066-1206
US

V. Phone/Fax

Practice location:
  • Phone: 908-756-6870
  • Fax: 908-756-5566
Mailing address:
  • Phone: 908-272-2534
  • Fax: 908-276-1830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00136200
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: