Provider Demographics
NPI:1124218649
Name:MCBRIDE, SUSAN KATHLEEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:KATHLEEN
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:KATHLEEN
Other - Last Name:BRUPBACHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:7504 BISSONNET ST # T-9
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-5502
Mailing Address - Country:US
Mailing Address - Phone:832-658-5260
Mailing Address - Fax:713-778-0859
Practice Address - Street 1:7504 BISSONNET ST # T-9
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-5502
Practice Address - Country:US
Practice Address - Phone:832-658-5260
Practice Address - Fax:713-778-0859
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX510481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1124218649Medicaid