Provider Demographics
NPI:1700940152
Name:SUTTON, LINDSAY
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:SUTTON
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 1:1156 N BROADWAY
Mailing Address - Street 2:ANDRUS CHILDREN'S CENTER
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1108
Mailing Address - Country:US
Mailing Address - Phone:914-965-3700
Mailing Address - Fax:914-965-3883
Practice Address - Street 1:50 DAYTON LN
Practice Address - Street 2:ANDRUS CHILDREN'S CENTER
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-2859
Practice Address - Country:US
Practice Address - Phone:914-736-3371
Practice Address - Fax:914-736-3372
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075628104100000X
NY0781201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY078120OtherNYS LICENSE
NY075628OtherNYS LICENSE #
NY00355940OtherAGENCY MEDICAID #
NY1285628552OtherAGENCY NPI
NY00355940OtherAGENCY MEDICAID #