| Suzanne J. Ennis Edd, Lcsw, P.c. | |
|
5 Blueberry Ridge Rd. East Setauket NY 11733-1503 | |
| (631) 689-8578 | |
| (631) 689-8578 |
| Full Name | Suzanne J. Ennis Edd, Lcsw, P.c. |
|---|---|
| Speciality | Social Worker |
| Location | 5 Blueberry Ridge Rd., East Setauket, New York |
| Authorized Official Name and Position | Suzanne J. Ennis (PSYCHOTHERAPIST) |
| Authorized Official Contact | 6316898578 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Suzanne J. Ennis Edd, Lcsw, P.c. P.o. Box 178 East Setauket NY 11733-0178 Ph: (631) 689-8578 | Suzanne J. Ennis Edd, Lcsw, P.c. 5 Blueberry Ridge Rd. East Setauket NY 11733-1503 Ph: (631) 689-8578 |
| NPI Number | 1942577432 |
|---|---|
| Provider Enumeration Date | 11/28/2011 |
| Last Update Date | 11/28/2011 |
| Medicare PECOS PAC ID | 9032384961 |
|---|---|
| Medicare Enrollment ID | O20111205000581 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942577432 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 026735 (New York) | Primary |
| Provider Name | Suzanne J Ennis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912914383 PECOS PAC ID: 9436331360 Enrollment ID: I20110314000346 |
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