=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114453875
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN KASSLER-TAUB
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2017
-----------------------------------------------------
Last Update Date | 05/02/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 BUNN DR SUITE 205
-----------------------------------------------------
City | PRINCETON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08540-1968
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-921-1994
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 177 KILDEE RD
-----------------------------------------------------
City | BELLE MEAD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08502-5710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-921-1994
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 44SC00433900
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------