Provider Demographics
NPI:1750314738
Name:GIVELBER, SUSAN HESS (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:HESS
Last Name:GIVELBER
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 1:35 MASON ST STE 214
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-1133
Mailing Address - Country:US
Mailing Address - Phone:315-789-1290
Mailing Address - Fax:316-781-5457
Practice Address - Street 1:35 MASON ST STE 214
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-1133
Practice Address - Country:US
Practice Address - Phone:315-789-1290
Practice Address - Fax:316-781-5457
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0557741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02514390Medicaid
NY02514390Medicaid