Provider Demographics
NPI:1174417471
Name:RAFFERTY, SUSANNA LOUISE (LCSW)
Entity type:Individual
Prefix:MS
First Name:SUSANNA
Middle Name:LOUISE
Last Name:RAFFERTY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:SUSANNA
Other - Middle Name:LOUISE
Other - Last Name:CAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3605 ENCANTO CIR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-5138
Mailing Address - Country:US
Mailing Address - Phone:469-438-8605
Mailing Address - Fax:
Practice Address - Street 1:3605 ENCANTO CIR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-5138
Practice Address - Country:US
Practice Address - Phone:469-438-8605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX351521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical