Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 35S100385300 | NJ |
Y | 103T00000X | Psychologist | 35S100385300 | NJ |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 35SI00385300 | NJ |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 35SI00385300 | NJ |
N | 103TM1800X | Intellectual & Developmental Disabilities | 35SI00385300 | NJ |
N | 103TS0200X | School Psychologist | 35SI00385300 | NJ |
NPI | 1164631313 |
---|---|
Provider Name | Dr. Susan A. Grossbard |
First Address | Wayne, NJ 07470-5536 |
Second Address | Wayne, NJ 07470-3535 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 02/02/2010 |