Provider Demographics
NPI:1538147574
Name:HUSLAGE, SUSAN MARTHA (PHD LCSW)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MARTHA
Last Name:HUSLAGE
Suffix:
Gender:F
Credentials:PHD LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 C AUER COURT
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816
Mailing Address - Country:US
Mailing Address - Phone:732-257-7705
Mailing Address - Fax:732-566-7727
Practice Address - Street 1:7 C AUER COURT
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816
Practice Address - Country:US
Practice Address - Phone:732-257-7705
Practice Address - Fax:732-566-7727
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100367000103T00000X
NJ44SC005374001041C0700X, 104100000X
NJ35SI00367000103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
104389OtherHEALTH NET MHN
104389OtherHEALTH NET MHN