Provider Demographics
NPI:1225641699
Name:BOYER, VANESSA SUSAN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:SUSAN
Last Name:BOYER
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 1:2746 STEUBEN HILL RD
Mailing Address - Street 2:
Mailing Address - City:HERKIMER
Mailing Address - State:NY
Mailing Address - Zip Code:13350-6309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5447 STATE ROUTE 28
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NY
Practice Address - Zip Code:13416-2000
Practice Address - Country:US
Practice Address - Phone:315-845-6800
Practice Address - Fax:315-845-8652
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0893071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical