Healthcare Provider Details

I. General information

NPI: 1982705307
Provider Name (Legal Business Name): SUSAN JANE PASTERNACK CSWR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 OLD ROUTE 17
MONTICELLO NY
12701-7013
US

IV. Provider business mailing address

PO BOX 645 3 SHADY MILL ROAD
SHADY NY
12409-0645
US

V. Phone/Fax

Practice location:
  • Phone: 845-794-1400
  • Fax: 845-796-7270
Mailing address:
  • Phone: 845-679-8079
  • Fax: 845-679-1278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number010075
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: