Healthcare Provider Details

I. General information

NPI: 1851671663
Provider Name (Legal Business Name): SUSAN GOMBERG KAUFMAN LCSW, LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSAN GOMBERG-KAUFMAN LCSW, LMSW

II. Dates (important events)

Enumeration Date: 08/24/2011
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 OLD MAMARONECK RD
WHITE PLAINS NY
10605-1723
US

IV. Provider business mailing address

2 OLD MAMARONECK RD
WHITE PLAINS NY
10605-1723
US

V. Phone/Fax

Practice location:
  • Phone: 914-948-4778
  • Fax:
Mailing address:
  • Phone: 914-948-4778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number076873
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number043379
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: