Healthcare Provider Details

I. General information

NPI: 1780454462
Provider Name (Legal Business Name): SUSANNA LAMM M.S.W., LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSAN ROSENTHAL

II. Dates (important events)

Enumeration Date: 01/04/2024
Last Update Date: 01/04/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

961 BROADWAY SUITE 106
WOODMERE NY
11598
US

IV. Provider business mailing address

961 BROADWAY SUITE 106
WOODMERE NY
11598-1028
US

V. Phone/Fax

Practice location:
  • Phone: 718-208-7377
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR-028942-1
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: