Provider Demographics
NPI:1013410471
Name:SUNDET, ISOLDE MARIE (MHC-LP)
Entity Type:Individual
Prefix:
First Name:ISOLDE
Middle Name:MARIE
Last Name:SUNDET
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 DUPONT ST APT 2B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-1178
Mailing Address - Country:US
Mailing Address - Phone:512-791-5268
Mailing Address - Fax:
Practice Address - Street 1:566 7TH AVE STE 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-1802
Practice Address - Country:US
Practice Address - Phone:212-564-7631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPO9478101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health