=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710197652
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN L ESSERMAN LCSW, IBCLC, LCCE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2007
-----------------------------------------------------
Last Update Date | 01/01/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 65 N MAPLE AVE
-----------------------------------------------------
City | RIDGEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07450-3233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-218-5206
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 MYRTLE AVE UNIT 578
-----------------------------------------------------
City | ALLENDALE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07401-7040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-218-5206
-----------------------------------------------------
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 | 44SC01023900
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 101819-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------