Provider Demographics
NPI:1578929782
Name:BARTELL, SUSAN S (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:S
Last Name:BARTELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BERNARD ST
Mailing Address - Street 2:
Mailing Address - City:PRT WASHINGTN
Mailing Address - State:NY
Mailing Address - Zip Code:11050-2902
Mailing Address - Country:US
Mailing Address - Phone:516-944-5856
Mailing Address - Fax:
Practice Address - Street 1:6 BERNARD ST
Practice Address - Street 2:
Practice Address - City:PRT WASHINGTN
Practice Address - State:NY
Practice Address - Zip Code:11050-2902
Practice Address - Country:US
Practice Address - Phone:516-944-5856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011350103TB0200X, 103TC0700X, 103TC2200X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily