Provider Demographics
NPI:1962418848
Name:WARSHAW, SUSAN C (EDD, ABPP)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:C
Last Name:WARSHAW
Suffix:
Gender:F
Credentials:EDD, ABPP
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:WARSHAW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:EDD
Mailing Address - Street 1:225 W 106TH ST
Mailing Address - Street 2:APT.11K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-3611
Mailing Address - Country:US
Mailing Address - Phone:212-496-1161
Mailing Address - Fax:
Practice Address - Street 1:11 RIVERSIDE DR
Practice Address - Street 2:SUITE 5
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2504
Practice Address - Country:US
Practice Address - Phone:212-496-1161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4559103T00000X, 103TC0700X, 103TP0814X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVN1521Medicare ID - Type Unspecified