Provider Demographics
NPI:1518319920
Name:FRATELLO, SUE ANN
Entity Type:Individual
Prefix:
First Name:SUE ANN
Middle Name:
Last Name:FRATELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUE ANN
Other - Middle Name:
Other - Last Name:GSCHWIND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:373 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CENTER MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11934-3510
Mailing Address - Country:US
Mailing Address - Phone:631-905-6884
Mailing Address - Fax:631-909-2629
Practice Address - Street 1:373 MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTER MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11934-3510
Practice Address - Country:US
Practice Address - Phone:631-905-6884
Practice Address - Fax:631-909-2629
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004452101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY711LG1OtherEMPIRE BLUE CROSS