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General NPI Number Information
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NPI Number | 1063859890
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Entity Type | Individual
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Provider Name | SUSAN B. ROANE PH.D.
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Gender | Female
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Dates
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Enumeration Date | 06/03/2013
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Last Update Date | 06/03/2013
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Provider Practice Location Address
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Address Line | 315 W 57TH ST SUITE 410
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City | NEW YORK
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State | NY
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Zip | 10019-3158
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Country | US
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Telephone | 347-725-0080
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Fax |
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Provider Business Mailing Address
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Address Line | 32 COURT ST SUITE 804
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City | BROOKLYN
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State | NY
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Zip | 11201-4421
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Country | US
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Telephone | 347-725-0080
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 012416
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License Number State | NY
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