Provider Demographics
NPI:1093844458
Name:MACVEAN, SUSAN PARKHILL (LCSW-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:PARKHILL
Last Name:MACVEAN
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 1:600 RIDGELY AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1001
Mailing Address - Country:US
Mailing Address - Phone:410-571-6780
Mailing Address - Fax:410-349-3346
Practice Address - Street 1:600 RIDGELY AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1001
Practice Address - Country:US
Practice Address - Phone:410-571-6780
Practice Address - Fax:410-349-3346
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD085511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
XXXXX7188 21401 000OtherTRICARE
283RMedicare ID - Type Unspecified