1528192879 NPI number — MS. SUZANNE C IVANCIC LCSW

Table of content: DR. CINDY PERRY MD (NPI 1679865398)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528192879 NPI number — MS. SUZANNE C IVANCIC LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IVANCIC
Provider First Name:
SUZANNE
Provider Middle Name:
C
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
IVANCIC
Provider Other First Name:
SUE
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1528192879
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
381 SCOTTSVILLE-CHILI ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHURCHVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14428
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-455-5230
Provider Business Mailing Address Fax Number:
585-624-7521

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
53 WEST MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HONEOYE FALLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-624-1540
Provider Business Practice Location Address Fax Number:
585-624-7521
Provider Enumeration Date:
03/16/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  R026427-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)