Provider Demographics
NPI:1891854121
Name:LEVY, SUSAN M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:M
Last Name:LEVY
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 1:112 DEWITT STREET
Mailing Address - Street 2:STE 203
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-2891
Mailing Address - Country:US
Mailing Address - Phone:315-422-4236
Mailing Address - Fax:315-422-4236
Practice Address - Street 1:112 DEWITT ST
Practice Address - Street 2:STE 203
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2890
Practice Address - Country:US
Practice Address - Phone:315-422-4236
Practice Address - Fax:315-422-4236
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR024928-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY56493-BMedicare ID - Type Unspecified