Provider Demographics
NPI:1992866354
Name:WEBSTER, SUSANNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSANNE
Middle Name:
Last Name:WEBSTER
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 1:105 MILLARD HILL RD
Mailing Address - Street 2:#4
Mailing Address - City:NEWFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14867-9200
Mailing Address - Country:US
Mailing Address - Phone:607-273-1346
Mailing Address - Fax:
Practice Address - Street 1:1083 WATERLOO GENEVA RD
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:NY
Practice Address - Zip Code:13165-1202
Practice Address - Country:US
Practice Address - Phone:315-539-4049
Practice Address - Fax:315-539-4394
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066434-11041C0700X
NY730766351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical