Provider Demographics
NPI:1134299175
Name:CEA, SUSAN L (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:L
Last Name:CEA
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 1:2887 CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-1705
Mailing Address - Country:US
Mailing Address - Phone:516-781-5720
Mailing Address - Fax:
Practice Address - Street 1:2887 CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-1705
Practice Address - Country:US
Practice Address - Phone:516-781-5720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0505801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNF5541Medicare ID - Type UnspecifiedSOCIAL WORKER