Healthcare Provider Details

I. General information

NPI: 1689444002
Provider Name (Legal Business Name): SUSAN VALAZZA LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 COUNTY ROUTE 64
MEXICO NY
13114-4219
US

IV. Provider business mailing address

110 W 6TH ST
OSWEGO NY
13126-2507
US

V. Phone/Fax

Practice location:
  • Phone: 315-963-4467
  • Fax:
Mailing address:
  • Phone: 315-963-4467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number017563
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: