Provider Demographics
NPI:1659514370
Name:ULRICH, SUSAN MARY (MS)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MARY
Last Name:ULRICH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 CEDAR CT
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:NY
Mailing Address - Zip Code:11948-2001
Mailing Address - Country:US
Mailing Address - Phone:631-379-7657
Mailing Address - Fax:
Practice Address - Street 1:38 CEDAR CT
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:NY
Practice Address - Zip Code:11948-2001
Practice Address - Country:US
Practice Address - Phone:631-379-7657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-10
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health