Provider Demographics
NPI:1861782989
Name:WEISSBACH, SUSAN G (LCSW)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:G
Last Name:WEISSBACH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:16 JAMES ROAD
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549
Mailing Address - Country:US
Mailing Address - Phone:914-737-7338
Mailing Address - Fax:914-737-1050
Practice Address - Street 1:1101 MAIN STREET
Practice Address - Street 2:C/O WJCS
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566
Practice Address - Country:US
Practice Address - Phone:914-737-7338
Practice Address - Fax:914-737-1050
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYP0445441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400048249Medicare PIN