Provider Demographics
NPI:1013072362
Name:MCNERNEY, SUSAN I
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:I
Last Name:MCNERNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:I
Other - Last Name:HICKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSWR, ACSW MSW
Mailing Address - Street 1:662 FARMERS MILLS RD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-3114
Mailing Address - Country:US
Mailing Address - Phone:845-225-4932
Mailing Address - Fax:845-225-4932
Practice Address - Street 1:662 FARMERS MILLS RD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-3114
Practice Address - Country:US
Practice Address - Phone:845-225-4932
Practice Address - Fax:845-225-4932
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
R0491321104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker