Provider Demographics
NPI:1508459819
Name:AGUILAR, SUSAN ALLISON (LMSW)
Entity Type:Individual
Prefix:
First Name:SUSAN ALLISON
Middle Name:
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:AGUILAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:550 W 171ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3356
Mailing Address - Country:US
Mailing Address - Phone:571-420-1136
Mailing Address - Fax:
Practice Address - Street 1:975 WALTON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-9512
Practice Address - Country:US
Practice Address - Phone:917-830-3365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109129104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker