Provider Demographics
NPI:1932375946
Name:KANE, SUSAN
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:KANE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:KANE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:350 CENTRAL PARK W
Mailing Address - Street 2:APT. 5G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6547
Mailing Address - Country:US
Mailing Address - Phone:212-666-4764
Mailing Address - Fax:212-531-1593
Practice Address - Street 1:350 CENTRAL PARK W
Practice Address - Street 2:APT. 5G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6547
Practice Address - Country:US
Practice Address - Phone:212-666-4764
Practice Address - Fax:212-531-1593
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO37336-1101YM0800X, 102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst