Provider Demographics
NPI:1306109483
Name:ZAWADZKI, SUSAN M (MS)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:ZAWADZKI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 HOPPING AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10307-1221
Mailing Address - Country:US
Mailing Address - Phone:917-783-5243
Mailing Address - Fax:
Practice Address - Street 1:76 HOPPING AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10307-1221
Practice Address - Country:US
Practice Address - Phone:917-783-5243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1790009103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst