Provider Demographics
NPI:1487678413
Name:STEVENS, SUSAN CORA (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:CORA
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:C
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:170 W 76TH ST
Mailing Address - Street 2:#501
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-8412
Mailing Address - Country:US
Mailing Address - Phone:212-787-8561
Mailing Address - Fax:212-787-8561
Practice Address - Street 1:170 W 76TH ST
Practice Address - Street 2:#501
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-8412
Practice Address - Country:US
Practice Address - Phone:212-787-8561
Practice Address - Fax:212-787-8561
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0735991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNG5911Medicare ID - Type Unspecified