Healthcare Provider Details

I. General information

NPI: 1861782989
Provider Name (Legal Business Name): SUSAN G. WEISSBACH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 06/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MAIN STREET C/O WJCS
PEEKSKILL NY
10566
US

IV. Provider business mailing address

16 JAMES ROAD
MOUNT KISCO NY
10549
US

V. Phone/Fax

Practice location:
  • Phone: 914-737-7338
  • Fax: 914-737-1050
Mailing address:
  • Phone: 914-737-7338
  • Fax: 914-737-1050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP044544
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: