Healthcare Provider Details

I. General information

NPI: 1851825905
Provider Name (Legal Business Name): SUSAN PEEK LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2017
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 SPRUCE STREET
NORTH COLLINS NY
14111
US

IV. Provider business mailing address

2101 SPRUCE STREET
NORTH COLLINS NY
14211
US

V. Phone/Fax

Practice location:
  • Phone: 716-337-3706
  • Fax: 716-337-2723
Mailing address:
  • Phone: 716-337-3706
  • Fax: 716-337-2723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number099904
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: