Provider Demographics
NPI:1114450152
Name:PLUNKET, SUSAN WITKO (PHD IN PSYCHOLOGY)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:WITKO
Last Name:PLUNKET
Suffix:
Gender:F
Credentials:PHD IN PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 5TH AVE
Mailing Address - Street 2:APT. 8A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4307
Mailing Address - Country:US
Mailing Address - Phone:212-505-2782
Mailing Address - Fax:
Practice Address - Street 1:25 5TH AVE
Practice Address - Street 2:APT. 8A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4307
Practice Address - Country:US
Practice Address - Phone:212-505-2782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010064-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist