Provider Demographics
NPI:1053856781
Name:MASON-GROSSMANN, SUZANNE (MHC)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:MASON-GROSSMANN
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-2138
Mailing Address - Country:US
Mailing Address - Phone:516-680-7008
Mailing Address - Fax:
Practice Address - Street 1:8 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2138
Practice Address - Country:US
Practice Address - Phone:516-680-7008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123456101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health