Provider Demographics
NPI:1346307352
Name:RETTEK HOCHBERG, SUSAN ILSA (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ILSA
Last Name:RETTEK HOCHBERG
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 1:579 OVINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-1701
Mailing Address - Country:US
Mailing Address - Phone:718-745-4952
Mailing Address - Fax:718-745-4952
Practice Address - Street 1:579 OVINGTON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-1701
Practice Address - Country:US
Practice Address - Phone:718-745-4952
Practice Address - Fax:718-745-4952
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010507103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical