Jacob, Susan Vivian

Jacob, Susan Vivian is an sole proprietor health care provider with primary practice located at 14 Vanderventer Ave , Port Washington NY 11050-3737. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical Child & Adolescent, which is considered as her primary health care specialty. Jacob, Susan Vivian can be contacted via phone (516) 944-3786.

Contact Information

Primary practice address
14 Vanderventer Ave Port Washington NY 11050-3737
Phone: (516) 944-3786
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical Child & Adolescent 103TC2200X 0077981 New York

Profile Details

NPI number 1467675819
LBN Legal business name Jacob, Susan Vivian
Credentials PHD
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 11th, 2007
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1467675819 NPPES
New York Other 0077981 LICENSE NUMBER

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