Provider Demographics
NPI:1457442428
Name:PENNY, SUSAN A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:A
Last Name:PENNY
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 1:15 STONEY HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:SAG HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11963
Mailing Address - Country:US
Mailing Address - Phone:631-725-6435
Mailing Address - Fax:631-725-6435
Practice Address - Street 1:15 STONEY HILL ROAD
Practice Address - Street 2:
Practice Address - City:SAG HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11963
Practice Address - Country:US
Practice Address - Phone:631-725-6435
Practice Address - Fax:631-725-6435
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR041109104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
7335547OtherVALUE OPTIONS
7335547OtherVALUE OPTIONS