Provider Demographics
NPI:1245397983
Name:PACER, SUSAN LANE (LCSW-R)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LANE
Last Name:PACER
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:LANE
Other - Last Name:PACER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:534 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-2740
Mailing Address - Country:US
Mailing Address - Phone:585-344-2048
Mailing Address - Fax:585-344-2048
Practice Address - Street 1:534 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-2740
Practice Address - Country:US
Practice Address - Phone:585-344-2048
Practice Address - Fax:585-344-2048
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR040407-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical