Provider Demographics
NPI:1548626617
Name:POLESE, SUSAN (LPC, NCC)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:POLESE
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 CROSBY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH SALEM
Mailing Address - State:NY
Mailing Address - Zip Code:10560-1043
Mailing Address - Country:US
Mailing Address - Phone:914-629-6378
Mailing Address - Fax:
Practice Address - Street 1:158 DANBURY RD
Practice Address - Street 2:SUITE 7
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-3227
Practice Address - Country:US
Practice Address - Phone:203-278-5116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-05
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health