Active NPI
Susan M Willis, LCSW
- Social Worker
- Ithaca, NY
National Provider Identifier
1356389092
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- RO452381
- Practice address
- 201 East Green St
Ithaca, NY 14850 - Phone
- (607) 274-6200
- Fax
- (607) 274-6316
- NPI assigned
- Jun 3, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | RO452381 | NY | Primary |
Addresses
Primary practice location
201 East Green St
Ithaca, NY 14850
Mailing address
113 Texas Lane
Ithaca, NY 14850
Phone (607) 274-6200
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RO452381 | NY | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149292800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1301961600000",
"number": "1356389092",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "113 TEXAS LANE",
"city": "ITHACA",
"state": "NY",
"postal_code": "14850",
"telephone_number": "607-274-6200",
"fax_number": "607-274-6316"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 EAST GREEN ST",
"city": "ITHACA",
"state": "NY",
"postal_code": "14850",
"telephone_number": "607-274-6200",
"fax_number": "607-274-6316"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "SUSAN",
"middle_name": "M",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-03",
"last_updated": "2011-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "RO452381",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ithaca, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.