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General NPI Number Information
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NPI Number | 1396058152
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Entity Type | Individual
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Provider Name | SUSAN VANDERPOOL R.N., L.C.S.W.-R
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Gender | Female
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Dates
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Enumeration Date | 07/22/2010
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 32636 COUNTY RD. 48
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City | PECONIC
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State | NY
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Zip | 11958
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Country | US
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Telephone | 631-276-1048
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Fax |
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Provider Business Mailing Address
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Address Line | P.O.BOX 432
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City | ORIENT
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State | NY
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Zip | 11957
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Country | US
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Telephone | 631-276-1048
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 679702
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R037455-1
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License Number State | NY
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