Provider Demographics
NPI:1376810804
Name:HALL, SUSAN PATRICIA
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:PATRICIA
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-1530
Mailing Address - Country:US
Mailing Address - Phone:845-353-7273
Mailing Address - Fax:845-353-7262
Practice Address - Street 1:336 N BROADWAY
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-1530
Practice Address - Country:US
Practice Address - Phone:845-353-7273
Practice Address - Fax:845-353-7262
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017541103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool