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General NPI Number Information
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NPI Number | 1992845796
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Entity Type | Individual
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Provider Name | SUSAN BIRENBAUM LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 09/26/2012
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Provider Practice Location Address
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Address Line | 1234 W BROADWAY
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City | HEWLETT
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State | NY
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Zip | 11557-1929
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Country | US
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Telephone | 516-637-9650
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Fax |
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Provider Business Mailing Address
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Address Line | 362 E PENN ST
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City | LONG BEACH
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State | NY
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Zip | 11561-4332
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Country | US
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Telephone | 516-432-0730
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R038015-1
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License Number State | NY
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