Provider Demographics
NPI:1083755581
Name:KRAEMER, SUSAN B (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:B
Last Name:KRAEMER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 W END AVE
Mailing Address - Street 2:APT. 6F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-3535
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:915 W END AVE
Practice Address - Street 2:APT. 6F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-3535
Practice Address - Country:US
Practice Address - Phone:212-865-0181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008218-1103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV61731Medicare ID - Type UnspecifiedEMPIRE MEDICARE SERVICES