Provider Demographics
NPI:1457437923
Name:SOPHIR-KUSNETZ, REBECCA
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:SOPHIR-KUSNETZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 CUTTERMILL RD
Mailing Address - Street 2:SUITE 399 NORTH
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3036
Mailing Address - Country:US
Mailing Address - Phone:917-751-4357
Mailing Address - Fax:516-773-2867
Practice Address - Street 1:98 CUTTERMILL RD
Practice Address - Street 2:SUITE 399 NORTH
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-3036
Practice Address - Country:US
Practice Address - Phone:917-751-4357
Practice Address - Fax:516-773-2867
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016356103G00000X, 103T00000X, 103TC0700X, 103TH0100X, 103TM1800X, 103TP2701X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation