=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619847241
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NURSE PRACTITIONER IN PSYCHIATRY AND FAMILY HEALTH PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2025
-----------------------------------------------------
Last Update Date | 12/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11714 228TH ST
-----------------------------------------------------
City | CAMBRIA HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11411-1720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-554-5594
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11714 228TH ST
-----------------------------------------------------
City | CAMBRIA HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11411-1720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-554-5594
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/FOUNDER
-----------------------------------------------------
Name | SUSANE HILARY FRITH-HEADLEY
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 917-856-3100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------