Provider Demographics
NPI:1699860940
Name:ANTELIS, SUSAN ELISE (LMHC, LCAT)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ELISE
Last Name:ANTELIS
Suffix:
Gender:F
Credentials:LMHC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 UNION AVE
Mailing Address - Street 2:SUITE # 5
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-3397
Mailing Address - Country:US
Mailing Address - Phone:516-825-6567
Mailing Address - Fax:516-825-6567
Practice Address - Street 1:10 UNION AVE
Practice Address - Street 2:SUITE # 5
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-3397
Practice Address - Country:US
Practice Address - Phone:516-825-6567
Practice Address - Fax:516-825-6567
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0002475101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health