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General NPI Number Information
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NPI Number | 1285003681
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Entity Type | Individual
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Provider Name | SIMON SUSSKIND LMHC
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Gender | Male
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Dates
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Enumeration Date | 09/16/2015
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 1132 BAY 24TH ST
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-1752
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Country | US
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Telephone | 718-813-5042
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Fax |
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Provider Business Mailing Address
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Address Line | 425 KINGS HWY
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City | BROOKLYN
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State | NY
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Zip | 11223-1629
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Country | US
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Telephone | 718-787-1100
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 009037-01
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License Number State | NY
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