Provider Demographics
NPI:1639291156
Name:DORNAN, SUSAN M (BS, CASAC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:DORNAN
Suffix:
Gender:F
Credentials:BS, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PARK ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4413
Mailing Address - Country:US
Mailing Address - Phone:518-926-3207
Mailing Address - Fax:518-926-3215
Practice Address - Street 1:340 MAIN ST
Practice Address - Street 2:
Practice Address - City:HUDSON FALLS
Practice Address - State:NY
Practice Address - Zip Code:12839-1530
Practice Address - Country:US
Practice Address - Phone:518-747-8001
Practice Address - Fax:518-747-8003
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18618101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)