Provider Demographics
NPI:1982757654
Name:KATZ, SUSAN ELIZABETH (LCSW)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:KATZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 WEST 55 STREET
Mailing Address - Street 2:APT 4A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-4500
Mailing Address - Country:US
Mailing Address - Phone:212-586-6864
Mailing Address - Fax:
Practice Address - Street 1:357 WEST 55 STREET
Practice Address - Street 2:APT 4A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-4500
Practice Address - Country:US
Practice Address - Phone:212-586-6864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR013503-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNOB222Medicare PIN