Provider Demographics
NPI:1053443580
Name:KULIS, SUSAN (MS)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:KULIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3202 TOWN WALK DR
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3733
Mailing Address - Country:US
Mailing Address - Phone:203-230-0790
Mailing Address - Fax:
Practice Address - Street 1:11109 76TH RD
Practice Address - Street 2:SUITE E5
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6424
Practice Address - Country:US
Practice Address - Phone:718-793-6963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000299103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis