Provider Demographics
NPI:1366421331
Name:GOMBOS, SUSAN D (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:D
Last Name:GOMBOS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 TREE TOP LN
Mailing Address - Street 2:
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522-3306
Mailing Address - Country:US
Mailing Address - Phone:914-693-3611
Mailing Address - Fax:914-693-2769
Practice Address - Street 1:260 GARTH RD
Practice Address - Street 2:SUITE 2H5
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-4051
Practice Address - Country:US
Practice Address - Phone:914-693-2769
Practice Address - Fax:914-693-2769
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR01657111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R47407Medicare UPIN
NYN44461Medicare ID - Type Unspecified