Provider Demographics
NPI:1134753429
Name:LONDON, SUSAN (LMSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:LONDON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PETER COOPER RD APT ME
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-6635
Mailing Address - Country:US
Mailing Address - Phone:917-693-9186
Mailing Address - Fax:
Practice Address - Street 1:5 PETER COOPER RD APT ME
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-6635
Practice Address - Country:US
Practice Address - Phone:917-693-9186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0755511041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY075551OtherLMSW