Healthcare Provider Details

I. General information

NPI: 1710027271
Provider Name (Legal Business Name): SUSANNE CAROL HAND LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 STOCKTON ST
PRINCETON NJ
08540-6813
US

IV. Provider business mailing address

14 AIKEN AVE
PRINCETON NJ
08540-5230
US

V. Phone/Fax

Practice location:
  • Phone: 609-924-0060
  • Fax:
Mailing address:
  • Phone: 609-924-4985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05308200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: