Provider Demographics
NPI:1316166879
Name:RYF, SUSAN HAZLETT (PSYD)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:HAZLETT
Last Name:RYF
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 REVONAH AVE
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-4006
Mailing Address - Country:US
Mailing Address - Phone:917-841-3201
Mailing Address - Fax:203-406-0260
Practice Address - Street 1:51 E 42ND ST
Practice Address - Street 2:SUITE 820
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-5404
Practice Address - Country:US
Practice Address - Phone:917-841-3201
Practice Address - Fax:203-406-0260
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013498-1103T00000X
CT002431103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVL9111Medicare ID - Type Unspecified