Provider Demographics
NPI:1144774068
Name:KNADE, SUSAN HALLIWELL (LCSW-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:HALLIWELL
Last Name:KNADE
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 1:4767 SAILORS RETREAT RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MD
Mailing Address - Zip Code:21654-1740
Mailing Address - Country:US
Mailing Address - Phone:410-310-6215
Mailing Address - Fax:
Practice Address - Street 1:121A N WEST ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-2709
Practice Address - Country:US
Practice Address - Phone:410-310-6215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-09
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25382101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD609550002Medicaid
MD520202701Medicaid