Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist |
NPI | 1013557412 |
---|---|
Provider Name | Susan Klosiewicz |
First Address | Cold Spring Harbor, NY 11724-1703 |
Second Address | Cold Spring Harbor, NY 11724-1703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2020 |
Last Update Date | 14/01/2020 |