Provider Demographics
NPI:1780706929
Name:LIGHT, SUSAN F (MS, LCSW)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:F
Last Name:LIGHT
Suffix:
Gender:F
Credentials:MS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 E 89TH ST APT 6D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-2326
Mailing Address - Country:US
Mailing Address - Phone:212-427-7572
Mailing Address - Fax:
Practice Address - Street 1:8 E 96TH ST # 3A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-0706
Practice Address - Country:US
Practice Address - Phone:212-427-7572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR026621-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical