| Sus Wellness Works Mental Health Clinic | |
|
1125 Fulton St Brooklyn NY 11238-2669 | |
| (347) 226-9025 | |
| Not Available |
| Full Name | Sus Wellness Works Mental Health Clinic |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1125 Fulton St, Brooklyn, New York |
| Authorized Official Name and Position | Oksana Marants (VP REVENUE CYCLE) |
| Authorized Official Contact | 6466297363 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sus Wellness Works Mental Health Clinic 463 Fashion Ave Fl 17 New York NY 10018-7595 Ph: (646) 629-7363 | Sus Wellness Works Mental Health Clinic 1125 Fulton St Brooklyn NY 11238-2669 Ph: (347) 226-9025 |
| NPI Number | 1053696195 |
|---|---|
| Provider Enumeration Date | 10/20/2011 |
| Last Update Date | 02/15/2024 |
| Certification Date | 02/15/2024 |
| Medicare PECOS PAC ID | 7810162468 |
|---|---|
| Medicare Enrollment ID | O20111208000751 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053696195 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | R033460-1 (New York) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 216593-1 (New York) | Primary |
| Provider Name | Tiffany A Cummins |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1174556914 PECOS PAC ID: 2062419427 Enrollment ID: I20061026000433 |
| Provider Name | James Gadiel Chavez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861508434 PECOS PAC ID: 5991706996 Enrollment ID: I20070117000447 |
| Provider Name | Janet Walpole |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881910479 PECOS PAC ID: 9032307400 Enrollment ID: I20101229000563 |
| Provider Name | Juan L Figueron |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326232778 PECOS PAC ID: 9830325992 Enrollment ID: I20131119001205 |
| Provider Name | Marianne E Brulhardt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952726564 PECOS PAC ID: 6305060757 Enrollment ID: I20140605000572 |
| Provider Name | Bolanle O Bello |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013160613 PECOS PAC ID: 2163641093 Enrollment ID: I20140908002373 |
| Provider Name | Sophia Ladouceur |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952714396 PECOS PAC ID: 0648596510 Enrollment ID: I20150312000370 |
| Provider Name | Sarah E Cohen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609265628 PECOS PAC ID: 6507166717 Enrollment ID: I20151119001681 |
| Provider Name | Brenda D Whitaker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366723579 PECOS PAC ID: 6901032820 Enrollment ID: I20160324001646 |
| Provider Name | Elizabeth A Lawrence |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609150861 PECOS PAC ID: 8820381999 Enrollment ID: I20160727000555 |
| Provider Name | Cheryl Ann Gould |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942322110 PECOS PAC ID: 7113207903 Enrollment ID: I20161214000258 |
| Provider Name | Fatima Siddiqui |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1629331053 PECOS PAC ID: 8820379738 Enrollment ID: I20170109002608 |
| Provider Name | Douglas Arvell Reed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457641300 PECOS PAC ID: 5597937839 Enrollment ID: I20170817003042 |
| Provider Name | Asia L Todd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730600891 PECOS PAC ID: 2668723149 Enrollment ID: I20180921002273 |
| Provider Name | Amy H Leeds |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346622107 PECOS PAC ID: 3173864709 Enrollment ID: I20190409002351 |
| Provider Name | Angela Yeung |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235605247 PECOS PAC ID: 4082944780 Enrollment ID: I20190923003125 |
| Provider Name | Stella O Okobi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376796052 PECOS PAC ID: 9335554500 Enrollment ID: I20210222000274 |
| Provider Name | Kristen V Hahn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821671264 PECOS PAC ID: 6204227150 Enrollment ID: I20220103001696 |
| Provider Name | Yuliya Sosunova-papish |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104296672 PECOS PAC ID: 1850761461 Enrollment ID: I20221222002140 |
| Provider Name | Anjum Ahmed |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1730520636 PECOS PAC ID: 4284005174 Enrollment ID: I20230201002273 |
| Provider Name | Toru Takada |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073983938 PECOS PAC ID: 9032561550 Enrollment ID: I20240122000080 |
| Provider Name | Jemimah Ming Chen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1710447719 PECOS PAC ID: 6406208834 Enrollment ID: I20240122000764 |
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