Provider Demographics
NPI:1164989984
Name:SUSSAL, CAROL M (LCSW SOLE PROPRIETOR)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:M
Last Name:SUSSAL
Suffix:
Gender:F
Credentials:LCSW SOLE PROPRIETOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W 14 ST
Mailing Address - Street 2:12B
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:10011-7226
Mailing Address - Country:US
Mailing Address - Phone:212-989-5675
Mailing Address - Fax:212-367-7323
Practice Address - Street 1:222 W 14 ST
Practice Address - Street 2:12B
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10011-7226
Practice Address - Country:US
Practice Address - Phone:212-989-5675
Practice Address - Fax:212-367-7323
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0138091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty