Provider Demographics
NPI:1760698195
Name:THOMAS, SUSAN (LMHC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 STATE HIGHWAY 72
Mailing Address - Street 2:POBOX 645
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-4434
Mailing Address - Country:US
Mailing Address - Phone:315-265-9554
Mailing Address - Fax:
Practice Address - Street 1:146 STATE HIGHWAY 72
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-4434
Practice Address - Country:US
Practice Address - Phone:315-265-9554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000417101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000417OtherNYSLMHC