Basic Information
| Provider Information | |||||||||
| NPI: | 1790906949 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BADER | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LICENSED MENTAL HEAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 166 HEDGEGARTH DRIVE | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146173638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5855447423 | ||||||||
| FaxNumber: | 5854619504 | ||||||||
| Practice Location | |||||||||
| Address1: | 2613 W HENRIETTA ROAD | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852794919 | ||||||||
| FaxNumber: | 5854619504 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 0007941 | NY | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.