Provider Demographics
NPI:1619008430
Name:SMITH, SUSAN C (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:C
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:L
Other - Last Name:WINKERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:46 NELSON ST
Mailing Address - Street 2:
Mailing Address - City:CAZENOVIA
Mailing Address - State:NY
Mailing Address - Zip Code:13035-1307
Mailing Address - Country:US
Mailing Address - Phone:315-882-2734
Mailing Address - Fax:315-443-4146
Practice Address - Street 1:46 NELSON ST
Practice Address - Street 2:
Practice Address - City:CAZENOVIA
Practice Address - State:NY
Practice Address - Zip Code:13035-1307
Practice Address - Country:US
Practice Address - Phone:315-882-2734
Practice Address - Fax:315-443-4146
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR032627-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health