Susan Joan Bourbin, LACSW-R

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

RO49752-1 Issued in NY

Practice address

15 Horseblock Place
Farmingville, NY 11738

Phone

(631) 854-2552

Fax

(631) 854-2550

NPI assigned

Nov 14, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1700958212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95 TULIPWOOD DR",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117255625",
            "telephone_number": "631-854-2552",
            "fax_number": "631-854-2550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 HORSEBLOCK PLACE",
            "city": "FARMINGVILLE",
            "state": "NY",
            "postal_code": "11738",
            "telephone_number": "631-854-2552",
            "fax_number": "631-854-2550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURBIN",
        "first_name": "SUSAN",
        "middle_name": "JOAN",
        "credential": "LACSW-R",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "RO49752-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SW LICENSE #",
            "identifier": "RO49752-1",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Diana Binder
• Erica Octavia Blas-Marquez, MSW
• Albert Bonanno, DDS
• Tamika Bontemps
• Ashley M Boruch
• Theresa F Brandow, MS
• Brent W Spears MD PC
• Jacqueline Katherine Brite, R.N.
• Brooklyn Nuclear Spect Imaging, PC
• Anderson Brown

• Clinical Social Worker in Farmingville, NY
• Providers in Farmingville, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.