Provider Demographics
NPI:1003500901
Name:BAMONTO, SUZANNE MICHELE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:MICHELE
Last Name:BAMONTO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SUZANNE
Other - Middle Name:BAMONTO
Other - Last Name:GRANEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14 STONELEIGH TRL
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-8951
Mailing Address - Country:US
Mailing Address - Phone:585-797-7938
Mailing Address - Fax:
Practice Address - Street 1:6539 ANTHONY DR STE A
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-1441
Practice Address - Country:US
Practice Address - Phone:585-398-8835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025192103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist