Provider Demographics
NPI:1821285578
Name:WILMOT, SUSAN M (MHS, LCADC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:M
Last Name:WILMOT
Suffix:
Gender:F
Credentials:MHS, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 483
Mailing Address - Street 2:
Mailing Address - City:DELAWARE WATER GAP
Mailing Address - State:PA
Mailing Address - Zip Code:18327-0483
Mailing Address - Country:US
Mailing Address - Phone:570-814-3358
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 1496
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-9675
Practice Address - Country:US
Practice Address - Phone:570-814-3358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00087300101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)