| Doctor Name: | SUSAN M DORNAN |
| NPI Number: | 1639291156 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | BS, CASAC |
| License Number: | 18618 |
| Business Practice Address: | 340 Main St Hudson Falls, NY - 128391530 |
| Business Phone Number: | 5187478001 |
| Business Fax Number: | 5187478003 |
| Mailing Address: | 100 Park St, GLENS FALLS |
| State: | NY |
| Postal Code: | 128014413 |
| Phone Number: | 5189263207 |
| Fax Number: | 5189263215 |
| NPI Enumeration Date: | 04/04/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 18618 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |