Provider Demographics
NPI:1417253485
Name:MORDUCH, SUSAN JANE (PHD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:JANE
Last Name:MORDUCH
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 1:547 SAW MILL RIVER RD
Mailing Address - Street 2:STE 1D
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-2154
Mailing Address - Country:US
Mailing Address - Phone:212-851-8102
Mailing Address - Fax:212-537-0102
Practice Address - Street 1:547 SAW MILL RIVER RD
Practice Address - Street 2:STE 1D
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-2154
Practice Address - Country:US
Practice Address - Phone:212-851-8102
Practice Address - Fax:212-537-0102
Is Sole Proprietor?:No
Enumeration Date:2011-02-08
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014634-1103T00000X
NY014634103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist