Provider Demographics
NPI:1144432998
Name:MEYER, SUSAN ELIZABETH (MA, RDT, LCAT)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:MEYER
Suffix:
Gender:F
Credentials:MA, RDT, LCAT
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:ELIZABETH
Other - Last Name:CLAYTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCAT
Mailing Address - Street 1:431 JANE ST
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-2616
Mailing Address - Country:US
Mailing Address - Phone:646-220-7324
Mailing Address - Fax:
Practice Address - Street 1:431 JANE ST
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-2616
Practice Address - Country:US
Practice Address - Phone:646-220-7324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000996101200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101200000XBehavioral Health & Social Service ProvidersDrama Therapist