Provider Demographics
NPI:1730189721
Name:CAPUTO, SUSAN (LCSW)
Entity type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:
Last Name:CAPUTO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4104
Mailing Address - Country:US
Mailing Address - Phone:718-339-8258
Mailing Address - Fax:
Practice Address - Street 1:257 15TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4988
Practice Address - Country:US
Practice Address - Phone:917-678-4628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-31
Last Update Date:2014-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR063704-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY98P3711OtherNY PRESBYTERIAN
NY02294888Medicaid
NYN277S1Medicare ID - Type Unspecified