Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | PR013037-1 | NY |
NPI | 1003054677 |
---|---|
Provider Name | Ms. Susannah Falk Shopsin |
First Address | New York, NY 10011-8530 |
Second Address | New York, NY 10011-8562 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2009 |
Last Update Date | 04/02/2009 |