Provider Demographics
NPI:1053696195
Name:SUS MENTAL HEALTH PROGRAMS, INC.
Entity type:Organization
Organization Name:SUS MENTAL HEALTH PROGRAMS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP REVENUE CYCLE
Authorized Official - Prefix:MS
Authorized Official - First Name:OKSANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARANTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-629-7363
Mailing Address - Street 1:463 FASHION AVE FL 17
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-7595
Mailing Address - Country:US
Mailing Address - Phone:646-629-7363
Mailing Address - Fax:855-370-9384
Practice Address - Street 1:1125 FULTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-2669
Practice Address - Country:US
Practice Address - Phone:347-226-9025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SERRVICES FOR THE UNDERSERVED, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-20
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
NY216593-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty