Provider Demographics
NPI:1780714659
Name:BOVE, SUSAN F (LCSW, BCD)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:F
Last Name:BOVE
Suffix:
Gender:F
Credentials:LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 S KAISERTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:12549-2330
Mailing Address - Country:US
Mailing Address - Phone:845-457-6278
Mailing Address - Fax:845-457-3017
Practice Address - Street 1:19 HILL ST
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-2113
Practice Address - Country:US
Practice Address - Phone:845-294-5856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0258951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical