Provider Demographics
NPI:1528192879
Name:IVANCIC, SUZANNE C (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:C
Last Name:IVANCIC
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SUE
Other - Middle Name:C
Other - Last Name:IVANCIC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:381 SCOTTSVILLE-CHILI ROAD
Mailing Address - Street 2:
Mailing Address - City:CHURCHVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14428
Mailing Address - Country:US
Mailing Address - Phone:585-455-5230
Mailing Address - Fax:585-624-7521
Practice Address - Street 1:53 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:HONEOYE FALLS
Practice Address - State:NY
Practice Address - Zip Code:14428
Practice Address - Country:US
Practice Address - Phone:585-624-1540
Practice Address - Fax:585-624-7521
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR026427-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical