Healthcare Provider Details

I. General information

NPI: 1982980553
Provider Name (Legal Business Name): SUSAN JOANNE BRETON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2011
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 BERKELEY PL
BROOKLYN NY
11217-3511
US

IV. Provider business mailing address

68 BERKELEY PL
BROOKLYN NY
11217-3511
US

V. Phone/Fax

Practice location:
  • Phone: 347-463-6161
  • Fax:
Mailing address:
  • Phone: 347-463-6161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number016070-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: