Provider Demographics
NPI:1144353574
Name:VULIJSCHER, SUSANA BEATRIZ (LCSW)
Entity type:Individual
Prefix:MS
First Name:SUSANA
Middle Name:BEATRIZ
Last Name:VULIJSCHER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 W 23RD ST
Mailing Address - Street 2:4 F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-2407
Mailing Address - Country:US
Mailing Address - Phone:212-242-0223
Mailing Address - Fax:212-242-0223
Practice Address - Street 1:170 W 23RD ST
Practice Address - Street 2:4 F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-2407
Practice Address - Country:US
Practice Address - Phone:212-242-0223
Practice Address - Fax:212-242-0223
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1041CO700X1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01803149Medicaid