Healthcare Provider Details

I. General information

NPI: 1235049800
Provider Name (Legal Business Name): SUSANNAH KATE GOODLOE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 AARON CT
KINGSTON NY
12401-2966
US

IV. Provider business mailing address

100 HARDENBURGH RD
ULSTER PARK NY
12487-5345
US

V. Phone/Fax

Practice location:
  • Phone: 845-834-7300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number129922-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: