Provider Demographics
NPI:1558626085
Name:CAVALLARO, SUSAN M (MED)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:CAVALLARO
Suffix:
Gender:F
Credentials:MED
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:PISARSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:300 WASHINGTON AVENUE EXT.
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203
Mailing Address - Country:US
Mailing Address - Phone:518-218-0000
Mailing Address - Fax:518-862-2175
Practice Address - Street 1:300 WASHINGTON AVENUE EXT.
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203
Practice Address - Country:US
Practice Address - Phone:518-218-0000
Practice Address - Fax:518-862-2175
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1740206010OtherGROUP NPI