Provider Demographics
NPI:1669692125
Name:SOUDER, SUSAN J (LCSW)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:J
Last Name:SOUDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W 98TH ST
Mailing Address - Street 2:#2E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-5628
Mailing Address - Country:US
Mailing Address - Phone:212-666-5196
Mailing Address - Fax:212-316-6868
Practice Address - Street 1:666 W END AVE
Practice Address - Street 2:SUITE 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-7357
Practice Address - Country:US
Practice Address - Phone:212-799-3123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO23585-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical