MEDICARE: DR. SUSAN D. MARX PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	35SI00235000	NJ

General Provider Information

NPI Number	:	1467559047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN D. MARX PSY.D.

Provider Business Mailing Address
First Line	:	28 MILLBURN AVE
Second Line	:
City	:	SPRINGFIELD
State	:	NJ
Zip	:	07081-1039
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	28 MILLBURN AVE
Second Line	:
City	:	SPRINGFIELD
State	:	NJ
Zip	:	07081-1039
Country	:	US
Telephone Number	:	973-379-6502
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2006
Last Update Date	:	07/08/2007

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