Provider Demographics
NPI:1437397726
Name:SKINNER, SUSAN (MA, BE-NCC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SKINNER
Suffix:
Gender:F
Credentials:MA, BE-NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2284 SARANAC AVE
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:LAKE PLACID
Mailing Address - State:NY
Mailing Address - Zip Code:12946-3558
Mailing Address - Country:US
Mailing Address - Phone:518-837-5222
Mailing Address - Fax:
Practice Address - Street 1:2284 SARANAC AVE
Practice Address - Street 2:SUITE 3B
Practice Address - City:LAKE PLACID
Practice Address - State:NY
Practice Address - Zip Code:12946-3558
Practice Address - Country:US
Practice Address - Phone:518-837-5222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor