Provider Demographics
NPI:1336299130
Name:COX, SUSAN VINCENT (MSW, MA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:VINCENT
Last Name:COX
Suffix:
Gender:F
Credentials:MSW, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 EASTON STATION RD
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:NY
Mailing Address - Zip Code:12834-5947
Mailing Address - Country:US
Mailing Address - Phone:518-692-7679
Mailing Address - Fax:518-677-2290
Practice Address - Street 1:15 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:NY
Practice Address - Zip Code:12816-1118
Practice Address - Country:US
Practice Address - Phone:518-677-2290
Practice Address - Fax:518-677-2290
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO36369-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB5015Medicare ID - Type Unspecified