Provider Demographics
NPI:1629292586
Name:KATZ, SUSAN W
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:W
Last Name:KATZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 WEST 77 STREET
Mailing Address - Street 2:1B
Mailing Address - City:NYC
Mailing Address - State:NY
Mailing Address - Zip Code:10024
Mailing Address - Country:US
Mailing Address - Phone:212-595-9808
Mailing Address - Fax:
Practice Address - Street 1:6 WEST 77 ST
Practice Address - Street 2:1B
Practice Address - City:NYC
Practice Address - State:NY
Practice Address - Zip Code:10024
Practice Address - Country:US
Practice Address - Phone:212-595-9808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR00955411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical