Provider Demographics
NPI:1164584876
Name:BIRENBAUM, SUSAN (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:BIRENBAUM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 E END AVE
Mailing Address - Street 2:APT14B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1106
Mailing Address - Country:US
Mailing Address - Phone:917-743-6764
Mailing Address - Fax:
Practice Address - Street 1:10 E END AVE
Practice Address - Street 2:APT14B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1106
Practice Address - Country:US
Practice Address - Phone:917-743-6764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-16
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0755811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN69P01Medicare PIN