Provider Demographics
NPI:1760635296
Name:FIRESTONE, SUSAN PAUL (LCAT-ATR-BC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:PAUL
Last Name:FIRESTONE
Suffix:
Gender:F
Credentials:LCAT-ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 WOOSTER ST APT 3E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-4391
Mailing Address - Country:US
Mailing Address - Phone:212-431-1303
Mailing Address - Fax:
Practice Address - Street 1:59 WOOSTER ST APT 3E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-4391
Practice Address - Country:US
Practice Address - Phone:212-431-1303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000684101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health