Provider Demographics
NPI:1801961008
Name:TRAUB, SUSANNE (LCSW MSW)
Entity type:Individual
Prefix:MRS
First Name:SUSANNE
Middle Name:
Last Name:TRAUB
Suffix:
Gender:F
Credentials:LCSW MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 BEACON DRIVE
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050
Mailing Address - Country:US
Mailing Address - Phone:516-883-3777
Mailing Address - Fax:516-767-4574
Practice Address - Street 1:35 BEACON DRIVE
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050
Practice Address - Country:US
Practice Address - Phone:516-883-3777
Practice Address - Fax:516-767-4574
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR0108011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7404592OtherGHI
NY7404592OtherEMPIRE VAL OPTS
NY7404592OtherEMPIRE VAL OPTS