Provider Demographics
NPI:1710037676
Name:BLUMENSON, SUSAN R (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:R
Last Name:BLUMENSON
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 1:24 5TH AVE
Mailing Address - Street 2:GROUND FLOOR SUITE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011
Mailing Address - Country:US
Mailing Address - Phone:212-473-5580
Mailing Address - Fax:212-614-0746
Practice Address - Street 1:24 5TH AVE
Practice Address - Street 2:GROUND FLOOR SUITE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011
Practice Address - Country:US
Practice Address - Phone:212-473-5580
Practice Address - Fax:212-614-0746
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000009102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst