Healthcare Provider Details

I. General information

NPI: 1578825089
Provider Name (Legal Business Name): STACY SUSMAN KUHN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 06/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 E 11TH ST # 51 4TH FLR
NEW YORK NY
10003-4602
US

IV. Provider business mailing address

410 E 57TH ST APT 10A
NEW YORK NY
10022-3059
US

V. Phone/Fax

Practice location:
  • Phone: 212-477-2600
  • Fax:
Mailing address:
  • Phone: 212-223-4080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number082456
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: