Provider Demographics
NPI:1811259104
Name:BUTTIGIEG, SUSAN FRANCELLE
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:FRANCELLE
Last Name:BUTTIGIEG
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 1:1 ODELL PLZ
Mailing Address - Street 2:FRED S. KELLER SCHOOL
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1402
Mailing Address - Country:US
Mailing Address - Phone:914-965-1152
Mailing Address - Fax:
Practice Address - Street 1:1 ODELL PLZ
Practice Address - Street 2:FRED S. KELLER SCHOOL
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1402
Practice Address - Country:US
Practice Address - Phone:914-965-1152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2017-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-15-19715103K00000X
NY897224141174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst