Healthcare Provider Details

I. General information

NPI: 1437849460
Provider Name (Legal Business Name): SUSAN KOWAL LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2023
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 NORTH ST
HARRISON NY
10528-1140
US

IV. Provider business mailing address

7 RAILSIDE AVE
WHITE PLAINS NY
10605-3408
US

V. Phone/Fax

Practice location:
  • Phone: 914-925-5959
  • Fax:
Mailing address:
  • Phone: 914-473-0673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number070473
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: