Provider Demographics
NPI:1447318431
Name:NEWBURGE, SUSAN KLEIN (PHD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:KLEIN
Last Name:NEWBURGE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 PITTSFORD PALMYRA RD
Mailing Address - Street 2:SUITE 135
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-3584
Mailing Address - Country:US
Mailing Address - Phone:585-678-4862
Mailing Address - Fax:585-625-3430
Practice Address - Street 1:6800 PITTSFORD PALMYRA RD
Practice Address - Street 2:SUITE 135
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-3584
Practice Address - Country:US
Practice Address - Phone:585-678-4862
Practice Address - Fax:585-625-3430
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016519-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP010016519OtherRIPA EXCELLUS
NY187557FCOtherPREFERRED CARE
NY7453833OtherRCIPA