Provider Demographics
NPI:1659438661
Name:HAWKINS, SUSAN CARLA (R CSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:CARLA
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:R CSW
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:CARLA
Other - Last Name:HAWKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:R CSW
Mailing Address - Street 1:7000 EAST GENESSEE STREET
Mailing Address - Street 2:BUILDING B
Mailing Address - City:FAYETTEVILLE,
Mailing Address - State:NY
Mailing Address - Zip Code:13224
Mailing Address - Country:US
Mailing Address - Phone:315-449-4556
Mailing Address - Fax:
Practice Address - Street 1:7000 E GENESEE ST
Practice Address - Street 2:BUILDING B
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-1131
Practice Address - Country:US
Practice Address - Phone:315-449-4556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY730377471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV54708BMedicare ID - Type Unspecified