Provider Demographics
NPI:1205262516
Name:STANTON, SUSAN MARIE (LMSW, CSSWS,)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MARIE
Last Name:STANTON
Suffix:
Gender:F
Credentials:LMSW, CSSWS,
Other - Prefix:MISS
Other - First Name:SUSANMARIE
Other - Middle Name:DONNA
Other - Last Name:STANTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW/CSSWS
Mailing Address - Street 1:165 N COLUMBUS AVE
Mailing Address - Street 2:MOUNT VERNON, BOARD OF EDUCATION
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10553-1101
Mailing Address - Country:US
Mailing Address - Phone:914-665-5000
Mailing Address - Fax:
Practice Address - Street 1:165 N COLUMBUS AVE
Practice Address - Street 2:MOUNT VERNON, BOARD OF EDUCATION
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10553-1101
Practice Address - Country:US
Practice Address - Phone:914-665-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY79630251041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool