Doctor Name: | SUSAN LYNNE ROELLER |
NPI Number: | 1447568001 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | RO36635 |
Business Practice Address: | 350 Martha Ave Bellport, NY - 117131525 |
Business Phone Number: | 6312866925 |
Business Fax Number: | |
Mailing Address: | 3 Brenner Ave, BETHPAGE |
State: | NY |
Postal Code: | 117144301 |
Phone Number: | 5169324395 |
Fax Number: | |
NPI Enumeration Date: | 09/16/2010 |
NPI Last Update Date: | 09/16/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | RO36635 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |