Healthcare Provider Details

I. General information

NPI: 1215107479
Provider Name (Legal Business Name): SUSAN F. OBRECHT L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 W 12TH ST SUITE 1-E
NEW YORK NY
10011-8563
US

IV. Provider business mailing address

59 W 12TH ST SUITE 1-E
NEW YORK NY
10011-8563
US

V. Phone/Fax

Practice location:
  • Phone: 212-627-2527
  • Fax:
Mailing address:
  • Phone: 212-627-2527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR-028742-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: