Provider Demographics
NPI:1457425324
Name:KAVALER-ADLER, SUSAN (PHD, ABPP)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:KAVALER-ADLER
Suffix:
Gender:F
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 E 9TH ST
Mailing Address - Street 2:STE 12P
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-5414
Mailing Address - Country:US
Mailing Address - Phone:212-674-5425
Mailing Address - Fax:718-785-3270
Practice Address - Street 1:115 E 9TH ST
Practice Address - Street 2:STE 12P
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-5414
Practice Address - Country:US
Practice Address - Phone:212-674-5425
Practice Address - Fax:718-785-3270
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004739103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV56132Medicare ID - Type Unspecified