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:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1467675819 | NPPES |
| New York | Other | 0077981 | LICENSE NUMBER |
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