Provider Demographics
NPI:1528086394
Name:ENSMINGER, SUZANNE T (LSW)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:T
Last Name:ENSMINGER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MS
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:POLYNIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:353 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SUNBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17801-3403
Mailing Address - Country:US
Mailing Address - Phone:570-286-9383
Mailing Address - Fax:570-286-6742
Practice Address - Street 1:353 MARKET ST
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:PA
Practice Address - Zip Code:17801-3403
Practice Address - Country:US
Practice Address - Phone:570-286-9383
Practice Address - Fax:570-286-6742
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW123544104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker