MEDICARE: SUSAN THOMAS 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	15185-01	NY

General Provider Information

NPI Number	:	1811739691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN THOMAS LCSW

Provider Business Mailing Address
First Line	:	28 TRACY LN
Second Line	:
City	:	EAST ISLIP
State	:	NY
Zip	:	11730-3413
Country	:	US
Telephone Number	:	631-793-9123
Fax Number	:

Provider Business Practice Location Address
First Line	:	28 TRACY LN
Second Line	:
City	:	EAST ISLIP
State	:	NY
Zip	:	11730-3413
Country	:	US
Telephone Number	:	631-793-9123
Fax Number	:

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

Provider Enumeration Date	:	06/11/2024
Last Update Date	:	06/11/2024

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Directions to “ SUSAN THOMAS LCSW” Practice Location

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