Provider Demographics
NPI:1780037333
Name:WINTER, SUSAN CARON (PHD)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:CARON
Last Name:WINTER
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 1:141 E 55TH ST
Mailing Address - Street 2:10C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4030
Mailing Address - Country:US
Mailing Address - Phone:212-774-7722
Mailing Address - Fax:
Practice Address - Street 1:141 E 55TH ST
Practice Address - Street 2:10C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4030
Practice Address - Country:US
Practice Address - Phone:212-774-7722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0215411103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist