NPIMap

Organization Active NPI

Susan Menahem Psychotherapy Service, PA

  • Clinical Social Worker
  • Highland Park, NJ
National Provider Identifier
1366934374
Registry record updated Jun 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
44SC05260700 Issued in NJ
Legal business name
SUSAN MENAHEM PSYCHOTHERAPY SERVICE, PA
Practice address
1119 Raritan Ave
Highland Park, NJ 08904-3639
Phone
(732) 246-8439
NPI assigned
Jun 5, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Cory Nichols, PHD
Title
Business Director
Phone
(732) 246-8439

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 44SC05260700 NJ Primary

Addresses

Primary practice location

1119 Raritan Ave
Highland Park, NJ 08904-3639

Mailing address

1119 Raritan Ave
Highland Park, NJ 08904-3639
Phone (732) 246-8439

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240603000554 NJ Part B Supplier - Clinic/Group Practice 1557803889 Receives reassigned benefits from 8 practitioners
Practice locations: Highland Park, NJ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1528156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528156800000",
    "number": "1366934374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1119 RARITAN AVE",
            "city": "HIGHLAND PARK",
            "state": "NJ",
            "postal_code": "089043639",
            "telephone_number": "732-246-8439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1119 RARITAN AVE",
            "city": "HIGHLAND PARK",
            "state": "NJ",
            "postal_code": "089043639",
            "telephone_number": "732-246-8439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSAN MENAHEM PSYCHOTHERAPY SERVICE, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-05",
        "last_updated": "2018-06-05",
        "status": "A",
        "authorized_official_last_name": "NICHOLS",
        "authorized_official_first_name": "CORY",
        "authorized_official_title_or_position": "BUSINESS DIRECTOR",
        "authorized_official_telephone_number": "732-246-8439",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC05260700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Highland Park, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.