Provider Demographics
NPI:1316243892
Name:GERSTEN, SUSANNAH REBECCA (LCSW)
Entity type:Individual
Prefix:MS
First Name:SUSANNAH
Middle Name:REBECCA
Last Name:GERSTEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:158 SACKETT ST
Mailing Address - Street 2:#1A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-2950
Mailing Address - Country:US
Mailing Address - Phone:718-360-8531
Mailing Address - Fax:
Practice Address - Street 1:406 7TH AVE
Practice Address - Street 2:#1F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-7306
Practice Address - Country:US
Practice Address - Phone:718-360-8531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY73 0775851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical