Provider Demographics
NPI:1356637250
Name:ANDERSEN, SUSAN M (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:ANDERSEN
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 1:6 WASHINGTON PLACE, #452
Mailing Address - Street 2:DEPT. OF PSYCHOLOGY, NEW YORK UNIVERSITY
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003
Mailing Address - Country:US
Mailing Address - Phone:212-998-7799
Mailing Address - Fax:
Practice Address - Street 1:6 WASHINGTON PLACE, #452
Practice Address - Street 2:DEPT. OF PSYCHOLOGY, NEW YORK UNIVERSITY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-998-7799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00984-1103T00000X
CAPT10287103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist