Provider Demographics
NPI:1740355650
Name:RAZAVI, SUSAN JEAN (LCSW-R)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:JEAN
Last Name:RAZAVI
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 FORT WASHINGTON AVE
Mailing Address - Street 2:APT 64A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-2054
Mailing Address - Country:US
Mailing Address - Phone:646-942-8705
Mailing Address - Fax:171-827-5606
Practice Address - Street 1:570 FORT WASHINGTON AVE
Practice Address - Street 2:APT 64A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-2054
Practice Address - Country:US
Practice Address - Phone:646-942-8705
Practice Address - Fax:171-827-5606
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR040328-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical