Provider Demographics
NPI:1447402623
Name:ZAJICEK, SUSAN DONNA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:DONNA
Last Name:ZAJICEK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 LYNWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-5212
Mailing Address - Country:US
Mailing Address - Phone:914-736-7371
Mailing Address - Fax:914-736-9344
Practice Address - Street 1:28 LYNWOOD RD
Practice Address - Street 2:
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-5212
Practice Address - Country:US
Practice Address - Phone:914-736-7371
Practice Address - Fax:914-736-9344
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-19
Last Update Date:2008-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03562111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical