Provider Demographics
NPI:1750825113
Name:PANETTI-STEWART, SUZANNE (CASAC, LCSW-R)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:PANETTI-STEWART
Suffix:
Gender:F
Credentials:CASAC, LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 537
Mailing Address - Street 2:
Mailing Address - City:INTERLAKEN
Mailing Address - State:NY
Mailing Address - Zip Code:14847
Mailing Address - Country:US
Mailing Address - Phone:607-351-9214
Mailing Address - Fax:
Practice Address - Street 1:103 W SENECA ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850
Practice Address - Country:US
Practice Address - Phone:607-351-9214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075751104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker