Provider Demographics
NPI:1497967632
Name:DUBIN, SUSAN J (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:DUBIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 W 83RD ST
Mailing Address - Street 2:2F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-5274
Mailing Address - Country:US
Mailing Address - Phone:212-439-1099
Mailing Address - Fax:
Practice Address - Street 1:49 W 86TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3601
Practice Address - Country:US
Practice Address - Phone:212-439-1099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045350-R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY13-41003969OtherTAX I.D. NUMBER