Provider Demographics
NPI:1740226927
Name:FAULKNER, SUSAN J (PSYD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12210-1707
Mailing Address - Country:US
Mailing Address - Phone:518-449-1255
Mailing Address - Fax:518-449-1255
Practice Address - Street 1:307 HAMILTON ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12210-1707
Practice Address - Country:US
Practice Address - Phone:518-449-1255
Practice Address - Fax:518-449-1255
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014519-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02144663Medicaid
NY02144663Medicaid