Provider Demographics
NPI:1003808973
Name:CHANDLER, SUSAN RUTH (LPCMH)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:RUTH
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:R
Other - Last Name:CHANDLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCMH
Mailing Address - Street 1:1311 N RODNEY ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-4259
Mailing Address - Country:US
Mailing Address - Phone:302-652-6545
Mailing Address - Fax:302-652-1811
Practice Address - Street 1:1311 N RODNEY ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-4259
Practice Address - Country:US
Practice Address - Phone:302-652-6545
Practice Address - Fax:302-652-1811
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC0000128101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000030235Medicaid