Basic Information
| Provider Information | |||||||||
| NPI: | 1962622530 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUSSWEIN | ||||||||
| FirstName: | MALKA | ||||||||
| MiddleName: | HARRIS | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | R-CSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 61 FANSHAW AVE | ||||||||
| Address2: | |||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107053716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146465932 | ||||||||
| FaxNumber: | 8453527293 | ||||||||
| Practice Location | |||||||||
| Address1: | 40 ROBERT PITT DR | ||||||||
| Address2: | |||||||||
| City: | MONSEY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109523333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453526800 | ||||||||
| FaxNumber: | 8453527293 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | R023641 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | R023641 | 01 | NY | LICENSE | OTHER |