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General NPI Number Information
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NPI Number | 1366421331
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Entity Type | Individual
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Provider Name | SUSAN D GOMBOS LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 260 GARTH RD SUITE 2H5
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City | SCARSDALE
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State | NY
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Zip | 10583-4051
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Country | US
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Telephone | 914-693-2769
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Fax | 914-693-2769
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Provider Business Mailing Address
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Address Line | 22 TREE TOP LN
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City | DOBBS FERRY
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State | NY
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Zip | 10522-3306
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Country | US
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Telephone | 914-693-3611
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Fax | 914-693-2769
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | PR0165711
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License Number State | NY
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