Provider Demographics
NPI:1063502490
Name:FEEHAN, SUZANNE B (LCSW CGP)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:B
Last Name:FEEHAN
Suffix:
Gender:F
Credentials:LCSW CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1577 TAUGHANNOCK BLVD
Mailing Address - Street 2:
Mailing Address - City:TRUMANSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14886-9114
Mailing Address - Country:US
Mailing Address - Phone:607-387-6760
Mailing Address - Fax:
Practice Address - Street 1:1577 TAUGHANNOCK BLVD
Practice Address - Street 2:
Practice Address - City:TRUMANSBURG
Practice Address - State:NY
Practice Address - Zip Code:14886-9114
Practice Address - Country:US
Practice Address - Phone:607-387-6760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR027975-11041C0700X
MA10169731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY121270OtherVALUE OPTIONS LCSW PROVID
NY121270OtherVALUE OPTIONS LCSW PROVID