Active NPI
Suzanne Alexandra Black
- Clinical Psychologist
- New York, NY
National Provider Identifier
1447776323
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 020429
- Practice address
- 345 Riverside Dr Apt 2F
New York, NY 10025-3452 - Phone
- (347) 761-2383
- NPI assigned
- Aug 22, 2017
- Last updated
- Aug 22, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 8
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Psychologist | 103TA0400X | NU | ||
| Adult Development & Aging Psychologist | 103TA0700X | 020429 | NY | |
| Cognitive & Behavioral Psychologist | 103TB0200X | 020429 | NY | |
| Clinical Psychologist | 103TC0700X | 020429 | NY | Primary |
| Family Psychologist | 103TF0000X | 020429 | NY | |
| Group Psychotherapy Psychologist | 103TP2701X | 020429 | NY | |
| Rehabilitation Psychologist | 103TR0400X | 020429 | NY | |
| Health Psychologist | 103TH0004X | NU |
Addresses
Primary practice location
345 Riverside Dr Apt 2F
New York, NY 10025-3452
Mailing address
C/O Bergelson
345 Riverside Drive, #2F
New York, NY 10025-3452
Phone (347) 761-2383
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 020429 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1503360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1503360000000",
"number": "1447776323",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "C/O BERGELSON",
"address_2": "345 RIVERSIDE DRIVE, #2F",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100253452",
"telephone_number": "347-761-2383"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "345 RIVERSIDE DR APT 2F",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100253452",
"telephone_number": "347-761-2383"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "SUZANNE",
"middle_name": "ALEXANDRA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-08-22",
"last_updated": "2017-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "103TA0400X",
"taxonomy_group": "",
"desc": "Psychologist, Addiction (Substance Use Disorder)",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "103TA0700X",
"taxonomy_group": "",
"desc": "Psychologist, Adult Development & Aging",
"state": "NY",
"license": "020429",
"primary": false
},
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "NY",
"license": "020429",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "020429",
"primary": true
},
{
"code": "103TF0000X",
"taxonomy_group": "",
"desc": "Psychologist, Family",
"state": "NY",
"license": "020429",
"primary": false
},
{
"code": "103TP2701X",
"taxonomy_group": "",
"desc": "Psychologist, Group Psychotherapy",
"state": "NY",
"license": "020429",
"primary": false
},
{
"code": "103TR0400X",
"taxonomy_group": "",
"desc": "Psychologist, Rehabilitation",
"state": "NY",
"license": "020429",
"primary": false
},
{
"code": "103TH0004X",
"taxonomy_group": "",
"desc": "Psychologist, Health",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.