Healthcare Provider Details

I. General information

NPI: 1609970037
Provider Name (Legal Business Name): SUSAN C HORAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

798 ROUTE 9 SUITE E SPECTRUM BEHAVIORAL MANAGEMENT SERV INC
FISHKILL NY
12524
US

IV. Provider business mailing address

20 DANIS AVENUE
POUGHKEEPSIE NY
12603-2408
US

V. Phone/Fax

Practice location:
  • Phone: 845-485-3500
  • Fax: 845-485-8780
Mailing address:
  • Phone: 845-485-3500
  • Fax: 845-485-8780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0549841
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2118800
Identifier TypeOTHER
Identifier State
Identifier IssuerCIGNA BEH HEALTH
# 2
Identifier617440
Identifier TypeOTHER
Identifier State
Identifier IssuerMVP HEALTH CARE
# 3
Identifier1033150
Identifier TypeOTHER
Identifier State
Identifier IssuerBEACON HEALTH STRAT
# 4
Identifier495291
Identifier TypeOTHER
Identifier State
Identifier IssuerVALUE OPTIONS CDPHP
# 5
Identifier495291
Identifier TypeOTHER
Identifier State
Identifier IssuerVALUE OPTIONS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: