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General NPI Number Information
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NPI Number | 1861280901
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Entity Type | Individual
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Provider Name | SUZANNE RAE DESHCHIDN LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/29/2025
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 16 BLAIR ST
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City | BLAIRSTOWN
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State | NJ
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Zip | 07825-3607
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Country | US
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Telephone | 845-521-0208
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 45
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City | HOPE
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State | NJ
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Zip | 07844-0045
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Country | US
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Telephone | 973-440-5502
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC06463100
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License Number State | NJ
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