MEDICARE: MS. SUSAN VOSS SHANLEY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	R0470541	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093776007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN VOSS SHANLEY LCSW

Provider Business Mailing Address
First Line	:	163 WOODLAWN AVE
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-1523
Country	:	US
Telephone Number	:	518-587-4239
Fax Number	:	518-587-4239

Provider Business Practice Location Address
First Line	:	163 WOODLAWN AVE
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-1523
Country	:	US
Telephone Number	:	518-581-9250
Fax Number	:	518-581-9250

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	08/11/2018

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