Provider Demographics
NPI:1326102880
Name:BLUESTONE KOPLOVITZ, SUSAN (SUSAN BLUESTONE,LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:BLUESTONE KOPLOVITZ
Suffix:
Gender:F
Credentials:SUSAN BLUESTONE,LCSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:BLUESTONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:345 E 72ND ST
Mailing Address - Street 2:3C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4623
Mailing Address - Country:US
Mailing Address - Phone:212-628-1759
Mailing Address - Fax:212-628-1759
Practice Address - Street 1:345 E 72ND ST
Practice Address - Street 2:3C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4623
Practice Address - Country:US
Practice Address - Phone:212-628-1759
Practice Address - Fax:212-628-1759
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0265301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical