Provider Demographics
NPI:1053487900
Name:SUNDERLAND, MARGARET (LCSW)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:SUNDERLAND
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 1:7900 TURIN RD
Mailing Address - Street 2:BEECHES PROF CAMPUS BLDG 3 STE 4
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-1900
Mailing Address - Country:US
Mailing Address - Phone:315-334-4555
Mailing Address - Fax:315-334-4554
Practice Address - Street 1:7900 TURIN RD
Practice Address - Street 2:BEECHES PROF CAMPUS BLDG 3 STE 4
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-1900
Practice Address - Country:US
Practice Address - Phone:315-334-4555
Practice Address - Fax:315-334-4554
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0494911101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYIA0567Medicare ID - Type Unspecified