Provider Demographics
NPI:1588688725
Name:BAXT, SUSAN G (MSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:G
Last Name:BAXT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BONTECOU LN
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-5516
Mailing Address - Country:US
Mailing Address - Phone:845-638-2196
Mailing Address - Fax:
Practice Address - Street 1:900 ROUTE 45
Practice Address - Street 2:SUITE 2
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-1134
Practice Address - Country:US
Practice Address - Phone:845-354-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP0222241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNS2361Medicare ID - Type Unspecified