Provider Demographics
NPI:1548875826
Name:O'GARA, SUSAN KATHLEEN (LCSW)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:KATHLEEN
Last Name:O'GARA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:KATHLEEN
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:354 BALLAD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-1232
Mailing Address - Country:US
Mailing Address - Phone:585-502-0228
Mailing Address - Fax:
Practice Address - Street 1:95 ALLENS CREEK RD STE 17
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3252
Practice Address - Country:US
Practice Address - Phone:585-502-0228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-13
Last Update Date:2020-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY089525101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty