Provider Demographics
NPI:1659617603
Name:DAREN, SUZY FAYE NATASHA (MFT)
Entity Type:Individual
Prefix:
First Name:SUZY
Middle Name:FAYE NATASHA
Last Name:DAREN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 N 4TH PL
Mailing Address - Street 2:APT. 8B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11249-3323
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:169 WYTHE AVE.
Practice Address - Street 2:SUITE 106
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11249-3102
Practice Address - Country:US
Practice Address - Phone:510-406-2168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-19
Last Update Date:2015-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000982106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist