Provider Demographics
NPI:1033207527
Name:DE QUATTRO, SUSAN J (LCSW-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:DE QUATTRO
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11249 LOCKWOOD DR.
Mailing Address - Street 2:STE. C
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-4564
Mailing Address - Country:US
Mailing Address - Phone:240-602-1694
Mailing Address - Fax:301-593-1033
Practice Address - Street 1:11249 LOCKWOOD DR
Practice Address - Street 2:STE. C
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4563
Practice Address - Country:US
Practice Address - Phone:240-602-1694
Practice Address - Fax:301-593-1033
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08801101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health