Provider Demographics
NPI:1154485662
Name:ROOS, SUSAN G (MSSW PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:G
Last Name:ROOS
Suffix:
Gender:F
Credentials:MSSW PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4025 WOODLAND PARK BLVD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013
Mailing Address - Country:US
Mailing Address - Phone:817-461-0200
Mailing Address - Fax:817-460-9771
Practice Address - Street 1:4025 WOODLAND PARK BLVD
Practice Address - Street 2:SUITE 290
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013
Practice Address - Country:US
Practice Address - Phone:817-461-0200
Practice Address - Fax:817-460-9771
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS0637104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
00S86YOtherBCBS