Provider Demographics
NPI:1154493419
Name:BRITAIN, SUSAN D (PHD)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:D
Last Name:BRITAIN
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:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:NY
Mailing Address - Zip Code:12936-0277
Mailing Address - Country:US
Mailing Address - Phone:518-877-7288
Mailing Address - Fax:518-877-7288
Practice Address - Street 1:315 USHERS RD
Practice Address - Street 2:
Practice Address - City:BALLSTON LAKE
Practice Address - State:NY
Practice Address - Zip Code:12019-1547
Practice Address - Country:US
Practice Address - Phone:518-877-7288
Practice Address - Fax:518-877-7288
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY06893-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC4144Medicare ID - Type Unspecified