Provider Demographics
NPI:1487673562
Name:SUSKIN, KATE D (MSW)
Entity Type:Individual
Prefix:MS
First Name:KATE
Middle Name:D
Last Name:SUSKIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-5284
Mailing Address - Country:US
Mailing Address - Phone:802-865-3450
Mailing Address - Fax:
Practice Address - Street 1:112 LAKE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5284
Practice Address - Country:US
Practice Address - Phone:802-865-3450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00010371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010841Medicaid
SU VN 3501Medicare ID - Type Unspecified