MEDICARE: SUSAN F EPSTEIN PHD, LICENSED PSYCHOLOGIST PLLC

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	261QD1600X	Developmental Disabilities Clinic/Center	016655	NY
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	016655	NY
3	251S00000X	Community/Behavioral Health Agency	016655	NY

General Provider Information

NPI Number	:	1841797420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSAN F EPSTEIN PHD, LICENSED PSYCHOLOGIST PLLC

Provider Business Mailing Address
First Line	:	3524 78TH ST APT B11
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-4705
Country	:	US
Telephone Number	:	646-250-8441
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 W 86TH ST APT 1C
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-3663
Country	:	US
Telephone Number	:	646-450-3633
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SUSAN F EPSTEIN
Credential	:	PHD
Telephone Number	:	646-450-3633

Provider Enumeration Date	:	04/10/2018
Last Update Date	:	04/10/2018

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