Provider Demographics
NPI:1356476014
Name:SUSSMAN, KAREN AMY (MA, CCC)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:AMY
Last Name:SUSSMAN
Suffix:
Gender:F
Credentials:MA, CCC
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:AMY
Other - Last Name:SUSSMAN-GOLDSTEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, CCC
Mailing Address - Street 1:184 W NICHOLAI ST
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-3828
Mailing Address - Country:US
Mailing Address - Phone:516-433-1822
Mailing Address - Fax:516-433-1840
Practice Address - Street 1:184 W NICHOLAI ST
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-3828
Practice Address - Country:US
Practice Address - Phone:516-433-1822
Practice Address - Fax:516-433-1840
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003259-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY112760147OtherTAX ID #