Provider Demographics
NPI:1619091600
Name:ESPINOSA, SUZANNAH L B (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNAH
Middle Name:L B
Last Name:ESPINOSA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 LAUREL HILL DR
Mailing Address - Street 2:
Mailing Address - City:WESTTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10998-3921
Mailing Address - Country:US
Mailing Address - Phone:845-624-2994
Mailing Address - Fax:845-697-4092
Practice Address - Street 1:589 FRANKLIN TPKE
Practice Address - Street 2:SUITE 8
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-1989
Practice Address - Country:US
Practice Address - Phone:845-624-2994
Practice Address - Fax:845-697-4092
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY15093103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent