Provider Demographics
NPI:1093955569
Name:SCHMID, SUSAN STALLONE (LCSW,CASAC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:STALLONE
Last Name:SCHMID
Suffix:
Gender:F
Credentials:LCSW,CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 VINEYARD RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-1256
Mailing Address - Country:US
Mailing Address - Phone:347-356-3943
Mailing Address - Fax:
Practice Address - Street 1:243 VINEYARD RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-1256
Practice Address - Country:US
Practice Address - Phone:347-356-3943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-24
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070716-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical