Provider Demographics
NPI:1093929820
Name:MONTALBANO, SUSAN LUCIA (LMHC, CASAC)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LUCIA
Last Name:MONTALBANO
Suffix:
Gender:F
Credentials:LMHC, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 RODSFIELD CT
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-5913
Mailing Address - Country:US
Mailing Address - Phone:631-486-3708
Mailing Address - Fax:
Practice Address - Street 1:514 LARKFIELD RD
Practice Address - Street 2:SUITE 4A
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-4211
Practice Address - Country:US
Practice Address - Phone:631-368-0354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003745101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health