Provider Demographics
NPI:1689284341
Name:BOYCE, SUSAN NICOLE (LCSW-R)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:NICOLE
Last Name:BOYCE
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:998 CROOKED HILL ROAD
Mailing Address - Street 2:BLDG 81-SOCR SOUTH
Mailing Address - City:WEST BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717
Mailing Address - Country:US
Mailing Address - Phone:631-761-2305
Mailing Address - Fax:631-761-2199
Practice Address - Street 1:998 CROOKED HILL ROAD
Practice Address - Street 2:BLDG 81-SOCR SOUTH
Practice Address - City:WEST BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717
Practice Address - Country:US
Practice Address - Phone:631-761-2305
Practice Address - Fax:631-761-2199
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR076810-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical