Basic Information
| Provider Information | |||||||||
| NPI: | 1790365948 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAGNUSON | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | PAIGE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17 RUTH PL | ||||||||
| Address2: | |||||||||
| City: | GLEN HEAD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115451030 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 481 MAIN ST STE 401 | ||||||||
| Address2: | |||||||||
| City: | NEW ROCHELLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 108016360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9143552440 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2021 | ||||||||
| LastUpdateDate: | 04/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 111528 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.