Provider Demographics
NPI:1710053392
Name:SAFFNER, SUSAN EILEEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:EILEEN
Last Name:SAFFNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BALLAD CIRCLE
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741
Mailing Address - Country:US
Mailing Address - Phone:631-580-2230
Mailing Address - Fax:631-647-3130
Practice Address - Street 1:1444 FIFTH AVE
Practice Address - Street 2:FAMILY SERVICE LEAGUE
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706
Practice Address - Country:US
Practice Address - Phone:631-647-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR039390 1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN214S1Medicare ID - Type Unspecified