Provider Demographics
NPI:1730308107
Name:SUSSKIND, FAY (PSYD, MS, LCSW)
Entity Type:Individual
Prefix:DR
First Name:FAY
Middle Name:
Last Name:SUSSKIND
Suffix:
Gender:F
Credentials:PSYD, MS, LCSW
Other - Prefix:DR
Other - First Name:FAY
Other - Middle Name:
Other - Last Name:TASSOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD, MS, LCSW
Mailing Address - Street 1:17 WESTOVER AVE
Mailing Address - Street 2:APARTMERT C-5
Mailing Address - City:CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-4824
Mailing Address - Country:US
Mailing Address - Phone:973-228-0042
Mailing Address - Fax:
Practice Address - Street 1:3 FAIRFIELD AVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-7629
Practice Address - Country:US
Practice Address - Phone:973-228-9008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC00766900104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQH#11690655OtherCREDENTIALING SERVICE