Healthcare Provider Details

I. General information

NPI: 1760318885
Provider Name (Legal Business Name): SUSAN TUTTLE OWEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 CHURCH ST STE 415
WHITE PLAINS NY
10601-1905
US

IV. Provider business mailing address

55 CHURCH ST STE 415
WHITE PLAINS NY
10601-1905
US

V. Phone/Fax

Practice location:
  • Phone: 646-389-5801
  • Fax: 929-368-4010
Mailing address:
  • Phone: 646-389-5801
  • Fax: 929-368-4010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: