Provider Demographics
NPI:1831579416
Name:ZEVELOFF, SUSANNAH (MS, MSW LICSW)
Entity type:Individual
Prefix:
First Name:SUSANNAH
Middle Name:
Last Name:ZEVELOFF
Suffix:
Gender:F
Credentials:MS, MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 BUTTERNUT RD
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-7303
Mailing Address - Country:US
Mailing Address - Phone:828-527-6380
Mailing Address - Fax:
Practice Address - Street 1:346 SHELBURNE RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4935
Practice Address - Country:US
Practice Address - Phone:828-527-6380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT01341881041C0700X
NCP009443104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker