Provider Demographics
NPI:1609875095
Name:SUSKIN, KARINE LEA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KARINE
Middle Name:LEA
Last Name:SUSKIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 BARSTOW RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2209
Mailing Address - Country:US
Mailing Address - Phone:516-466-9726
Mailing Address - Fax:516-466-1809
Practice Address - Street 1:29 BARSTOW RD
Practice Address - Street 2:SUITE 205
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2209
Practice Address - Country:US
Practice Address - Phone:516-466-9726
Practice Address - Fax:516-466-1809
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015163103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02383782Medicaid
NY02383782Medicaid