Active NPI
Susan Ruth Robertson, PH. D.
- Clinical Psychologist
- Brooklyn, NY
National Provider Identifier
1881903631
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 007507
- Practice address
- 25 Flatbush Ave
3Rd Floor
Brooklyn, NY 11217-1101 - Phone
- (718) 875-1420
- Fax
- (718) 875-4596
- NPI assigned
- Sep 28, 2010
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 007507 | NY | Primary |
Addresses
Primary practice location
25 Flatbush Ave
3Rd Floor
Brooklyn, NY 11217-1101
Mailing address
316 W 22ND St
5
New York, NY 10011-2689
Phone (212) 627-2624
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 007507 | NY | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1285632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1285632000000",
"number": "1881903631",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "316 W 22ND ST",
"address_2": "5",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100112689",
"telephone_number": "212-627-2624"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25 FLATBUSH AVE",
"address_2": "3RD FLOOR",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112171101",
"telephone_number": "718-875-1420",
"fax_number": "718-875-4596"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTSON",
"first_name": "SUSAN",
"middle_name": "RUTH",
"name_prefix": "Ms.",
"credential": "PH. D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-09-28",
"last_updated": "2010-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "007507",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.