Provider Demographics
NPI:1912063785
Name:PALMGREN, SUSAN ELISABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ELISABETH
Last Name:PALMGREN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:ELISABETH
Other - Last Name:PACKARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1090 AMSTERDAM AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-1737
Mailing Address - Country:US
Mailing Address - Phone:212-523-5134
Mailing Address - Fax:212-523-4069
Practice Address - Street 1:1090 AMSTERDAM AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1737
Practice Address - Country:US
Practice Address - Phone:212-523-5134
Practice Address - Fax:212-523-4069
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017203-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist