Provider Demographics
NPI:1912054552
Name:JONES, FARA SUSSMAN (MA, LCSW)
Entity Type:Individual
Prefix:
First Name:FARA
Middle Name:SUSSMAN
Last Name:JONES
Suffix:
Gender:F
Credentials:MA, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 WINDSOR PL # 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-1259
Mailing Address - Country:US
Mailing Address - Phone:917-359-3335
Mailing Address - Fax:
Practice Address - Street 1:406 7TH AVE
Practice Address - Street 2:SUITE 1F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-7306
Practice Address - Country:US
Practice Address - Phone:917-359-3335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068361-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical