Provider Demographics
NPI:1255585204
Name:SUSSMAN, RACHEL
Entity type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:
Last Name:SUSSMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:SUSSMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:205 W 89TH ST
Mailing Address - Street 2:8G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1828
Mailing Address - Country:US
Mailing Address - Phone:212-769-0533
Mailing Address - Fax:
Practice Address - Street 1:205 W 89TH ST
Practice Address - Street 2:8G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-1828
Practice Address - Country:US
Practice Address - Phone:212-769-0533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070997-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical