Healthcare Provider Details

I. General information

NPI: 1164081469
Provider Name (Legal Business Name): SUSAN SAPEK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 06/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 WESTCHESTER AVE STE 300
PURCHASE NY
10577-2554
US

IV. Provider business mailing address

8 S STEUBEN CT APT B
BEACON NY
12508-1308
US

V. Phone/Fax

Practice location:
  • Phone: 914-328-2868
  • Fax:
Mailing address:
  • Phone: 845-797-5187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1077832
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: