Provider Demographics
NPI:1891846358
Name:WEISSMAN, SUSAN MILLER (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MILLER
Last Name:WEISSMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 FASHION AVE
Mailing Address - Street 2:SUITE 403
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-1603
Mailing Address - Country:US
Mailing Address - Phone:212-869-0956
Mailing Address - Fax:212-819-9465
Practice Address - Street 1:570 FASHION AVE
Practice Address - Street 2:SUITE 403
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-1603
Practice Address - Country:US
Practice Address - Phone:212-869-0956
Practice Address - Fax:212-819-9465
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY73 0739451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNV2671Medicare PIN