Provider Demographics
NPI:1043718240
Name:ZOLA, SUSAN G (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:G
Last Name:ZOLA
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 1:276 ALTESSA BLVD
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-5239
Mailing Address - Country:US
Mailing Address - Phone:631-332-2213
Mailing Address - Fax:
Practice Address - Street 1:276 ALTESSA BLVD
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-5239
Practice Address - Country:US
Practice Address - Phone:631-332-2213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-23
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0785301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT012822OtherCONNECTICUT LICENSING BOARD
NY078530-01OtherNEW YORK STATE LICENSING BOARD
VA0904015623OtherVIRGINIA LICENSING BOARD
MELC22505OtherMAINE LICENSING BOARD
MALICSW126256OtherMASSACHUSETTS LICENSING BOARD
FLSW19387OtherFLORIDA LICENSING BOARD
TX110738OtherTEXAS LICENSING BOARD
2021-3584OtherCSAT
NH3045OtherNEW HAMPSHIRE LICENSING BOARD
AZLCSW-21778OtherARIZONA LICENSING BOARD