MEDICARE: DR. SUSAN KAVALER-ADLER PHD, ABPP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	004739	NY

General Provider Information

NPI Number	:	1457425324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN KAVALER-ADLER PHD, ABPP

Provider Business Mailing Address
First Line	:	115 E 9TH ST
Second Line	:	STE 12P
City	:	NEW YORK
State	:	NY
Zip	:	10003-5414
Country	:	US
Telephone Number	:	212-674-5425
Fax Number	:	718-785-3270

Provider Business Practice Location Address
First Line	:	115 E 9TH ST
Second Line	:	STE 12P
City	:	NEW YORK
State	:	NY
Zip	:	10003-5414
Country	:	US
Telephone Number	:	212-674-5425
Fax Number	:	718-785-3270

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	03/14/2013

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