Provider Demographics
NPI:1316376015
Name:O'DONOGHUE, SUZANNE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:
Last Name:O'DONOGHUE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19410 87TH RD
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-1402
Mailing Address - Country:US
Mailing Address - Phone:718-343-5854
Mailing Address - Fax:
Practice Address - Street 1:1016 162ND ST
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-2124
Practice Address - Country:US
Practice Address - Phone:917-224-9799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0692551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical