Provider Demographics
NPI:1033487103
Name:PAULAY, SUSANNA R (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSANNA
Middle Name:R
Last Name:PAULAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 POND RD
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-3746
Mailing Address - Country:US
Mailing Address - Phone:516-628-6153
Mailing Address - Fax:516-922-2098
Practice Address - Street 1:125 POND RD
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-3746
Practice Address - Country:US
Practice Address - Phone:516-628-6153
Practice Address - Fax:516-922-2098
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR044358-11041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool