Provider Demographics
NPI:1851671663
Name:KAUFMAN, SUSAN GOMBERG (LCSW, LMSW)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:GOMBERG
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:LCSW, LMSW
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:GOMBERG-KAUFMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, LMSW
Mailing Address - Street 1:2 OLD MAMARONECK RD
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1723
Mailing Address - Country:US
Mailing Address - Phone:914-948-4778
Mailing Address - Fax:
Practice Address - Street 1:2 OLD MAMARONECK RD
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1723
Practice Address - Country:US
Practice Address - Phone:914-948-4778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0768731041C0700X
NY0433791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical