Provider Demographics
NPI:1376609511
Name:COMPTON, SUSAN VICTORIA (PHD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:VICTORIA
Last Name:COMPTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E BUFFALO ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-4266
Mailing Address - Country:US
Mailing Address - Phone:607-539-7406
Mailing Address - Fax:
Practice Address - Street 1:120 E BUFFALO ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4266
Practice Address - Country:US
Practice Address - Phone:607-275-9642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000117-1106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist