MEDICARE: MRS. SUSAN S THOMAS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	066704	NY
2	1041C0700X	Clinical Social Worker	R066704-1	NY

General Provider Information

NPI Number	:	1841437084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN S THOMAS LCSW

Provider Business Mailing Address
First Line	:	1465 NORTH RD
Second Line	:	PO BOX 124
City	:	TULLY
State	:	NY
Zip	:	13159-9442
Country	:	US
Telephone Number	:	315-243-1578
Fax Number	:

Provider Business Practice Location Address
First Line	:	1465 NORTH RD
Second Line	:
City	:	TULLY
State	:	NY
Zip	:	13159-9442
Country	:	US
Telephone Number	:	315-243-1578
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2009
Last Update Date	:	05/08/2019

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