Healthcare Provider Details

I. General information

NPI: 1538176771
Provider Name (Legal Business Name): SUZANNE E TOMB LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 06/12/2020
Certification Date: 06/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 SKI BOWL RD
NORTH CREEK NY
12853-2607
US

IV. Provider business mailing address

9 CAREY RD
QUEENSBURY NY
12804-7880
US

V. Phone/Fax

Practice location:
  • Phone: 518-251-2541
  • Fax: 518-251-3055
Mailing address:
  • Phone: 518-761-0300
  • Fax: 518-824-2388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR045085
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: