Provider Demographics
NPI:1275687774
Name:STERNGOLD, SUSAN (MSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:STERNGOLD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 LANCASTER DR
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-7424
Mailing Address - Country:US
Mailing Address - Phone:845-357-7837
Mailing Address - Fax:508-546-0704
Practice Address - Street 1:5 LANCASTER DR
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-7424
Practice Address - Country:US
Practice Address - Phone:845-357-7837
Practice Address - Fax:508-546-0704
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070229-11041C0700X
NJ44SC048969001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01917775Medicaid
NYNC0901Medicare ID - Type Unspecified