| Susan Connelly Licensed Clinical Social Worker, P.c. | |
|
515 E. Main St Endicott NY 13760-5023 | |
| (607) 427-4430 | |
| (607) 444-3319 |
| Full Name | Susan Connelly Licensed Clinical Social Worker, P.c. |
|---|---|
| Speciality | Social Worker |
| Location | 515 E. Main St, Endicott, New York |
| Authorized Official Name and Position | Susan L Connelly (OWNER/PROVIDER) |
| Authorized Official Contact | 6074274430 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Susan Connelly Licensed Clinical Social Worker, P.c. 515 E Main St Endicott NY 13760-5023 Ph: (607) 427-4430 | Susan Connelly Licensed Clinical Social Worker, P.c. 515 E. Main St Endicott NY 13760-5023 Ph: (607) 427-4430 |
| NPI Number | 1467930453 |
|---|---|
| Provider Enumeration Date | 08/01/2018 |
| Last Update Date | 04/23/2020 |
| Certification Date | 04/23/2020 |
| Medicare PECOS PAC ID | 4789013939 |
|---|---|
| Medicare Enrollment ID | O20200409000682 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467930453 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 043911-1 (New York) | Primary |
| Provider Name | Susan L Connelly |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043311442 PECOS PAC ID: 5395807952 Enrollment ID: I20081217000154 |
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