Provider Demographics
NPI:1720224793
Name:SHUSTER, SUSAN A
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:SHUSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:A
Other - Last Name:LEFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:6 HASTINGS RD
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-1311
Mailing Address - Country:US
Mailing Address - Phone:845-354-4055
Mailing Address - Fax:
Practice Address - Street 1:6 HASTINGS RD
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-1311
Practice Address - Country:US
Practice Address - Phone:845-354-4055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075363-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN54181Medicare UPIN