Individual
SUSAN NEWNOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC
Contact information
Practice address
848 W BAY AVE, BARNEGAT, NJ 08005-2126
(609) 660-0797
Mailing address
PO BOX 2036, LAKEWOOD, NJ 08701-8036
(732) 367-4700
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
37CA00139700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0029807
—
NJ
Enumeration date
08/10/2022
Last updated
08/10/2022
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