Provider Demographics
NPI:1386791804
Name:STIX, SUSAN HURD (ACSW BCD)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:HURD
Last Name:STIX
Suffix:
Gender:F
Credentials:ACSW BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 HARBOR LANE
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11576-1118
Mailing Address - Country:US
Mailing Address - Phone:516-621-9131
Mailing Address - Fax:516-621-0801
Practice Address - Street 1:32 HARBOR LANE
Practice Address - Street 2:
Practice Address - City:ROSLYN HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11576-1118
Practice Address - Country:US
Practice Address - Phone:516-621-9131
Practice Address - Fax:516-621-0801
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR02587611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN24451Medicare ID - Type Unspecified