Provider Demographics
NPI:1447380514
Name:WRIGHT, SUSAN DENISE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:DENISE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5820 MAIN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5776
Mailing Address - Country:US
Mailing Address - Phone:716-565-1510
Mailing Address - Fax:716-565-1511
Practice Address - Street 1:5820 MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5776
Practice Address - Country:US
Practice Address - Phone:716-565-1510
Practice Address - Fax:716-565-1511
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR03563211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY291081Medicare ID - Type Unspecified