Healthcare Provider Details

I. General information

NPI: 1760112767
Provider Name (Legal Business Name): SUSANNE E BERMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSANNE E BERMAN LCSW

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 LAKE DRIVE STE #222
LAKE PEEKSKILL NY
10537-1243
US

IV. Provider business mailing address

132 LAKE DRIVE STE #222
LAKE PEEKSKILL NY
10537-1243
US

V. Phone/Fax

Practice location:
  • Phone: 347-450-5744
  • Fax:
Mailing address:
  • Phone: 347-450-5744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number058201
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number103111
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: