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General NPI Number Information
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NPI Number | 1255131090
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Entity Type | Organization
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Legal Business Name | SUZANNE O'DONOGHUE, LICENSED CLINICAL SOCIAL WORKER
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Dates
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Enumeration Date | 03/18/2025
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 8919 PONTIAC ST
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City | QUEENS VILLAGE
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State | NY
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Zip | 11427-2731
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Country | US
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Telephone | 917-224-9799
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Fax |
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Provider Business Mailing Address
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Address Line | 8250 241ST ST
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City | BELLEROSE
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State | NY
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Zip | 11426-1310
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Country | US
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Telephone | 917-224-9799
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. SUZANNE MARIE O'DONOGHUE
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Credential | LCSW
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Telephone | 917-224-9799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 221700000X
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Taxonomy Name | Art Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number |
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License Number State |
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