Provider Demographics
NPI:1073826194
Name:BIENVENU, SUSAN JEAN (MAC, LAC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:JEAN
Last Name:BIENVENU
Suffix:
Gender:F
Credentials:MAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17013 CLEAR CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-5143
Mailing Address - Country:US
Mailing Address - Phone:240-839-1675
Mailing Address - Fax:
Practice Address - Street 1:10111 COLESVILLE RD
Practice Address - Street 2:SUITE 123
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-2427
Practice Address - Country:US
Practice Address - Phone:240-839-1675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01823171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist