Provider Demographics
NPI:1023129863
Name:LOGUE, SUZANNE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:
Last Name:LOGUE
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 1:24 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778-9520
Mailing Address - Country:US
Mailing Address - Phone:631-849-4893
Mailing Address - Fax:
Practice Address - Street 1:24 LOCUST ST
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-9520
Practice Address - Country:US
Practice Address - Phone:631-849-4893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073162-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical