Provider Demographics
NPI:1174067268
Name:LEACH, SUSAN BLOCH (LCSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:BLOCH
Last Name:LEACH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SUSAN BLOCH LEACH
Mailing Address - Street 2:59 GLENNA LITTLE TRAIL
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743
Mailing Address - Country:US
Mailing Address - Phone:516-819-9940
Mailing Address - Fax:
Practice Address - Street 1:SUSAN BLOCH LEACH
Practice Address - Street 2:59 GLENNA LITTLE TRAIL
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743
Practice Address - Country:US
Practice Address - Phone:516-819-9940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-08
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY089939-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical