Provider Demographics
NPI:1871677021
Name:GOLD, SUSAN LYNN (LCSW-R, ACSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LYNN
Last Name:GOLD
Suffix:
Gender:F
Credentials:LCSW-R, ACSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:LYNN
Other - Last Name:DIAMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-R, ACSW
Mailing Address - Street 1:13 BERKELEY CT
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10930-2600
Mailing Address - Country:US
Mailing Address - Phone:845-827-6367
Mailing Address - Fax:
Practice Address - Street 1:13 BERKELEY CT
Practice Address - Street 2:
Practice Address - City:HIGHLAND MILLS
Practice Address - State:NY
Practice Address - Zip Code:10930-2600
Practice Address - Country:US
Practice Address - Phone:845-827-6367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR040992-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist