Provider Demographics
NPI:1467663567
Name:BUDNICK, SUSAN (PSYCHOANALYST)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:BUDNICK
Suffix:
Gender:F
Credentials:PSYCHOANALYST
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:BUDNICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYCHOANALYST
Mailing Address - Street 1:PO BOX 406
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:CT
Mailing Address - Zip Code:06756-0406
Mailing Address - Country:US
Mailing Address - Phone:860-618-3722
Mailing Address - Fax:860-371-2654
Practice Address - Street 1:21 BRYNMOOR COURT
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:CT
Practice Address - Zip Code:06756-0406
Practice Address - Country:US
Practice Address - Phone:860-618-3722
Practice Address - Fax:860-371-2654
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000221102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst