Provider Demographics
NPI:1184637944
Name:ELMENDORF, SUSAN STEIN (MSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:STEIN
Last Name:ELMENDORF
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:STEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:3000 CONNECTICUT AVE NW STE 134
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-2533
Mailing Address - Country:US
Mailing Address - Phone:202-462-1957
Mailing Address - Fax:
Practice Address - Street 1:3000 CONNECTICUT AVE NW STE 134
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-2533
Practice Address - Country:US
Practice Address - Phone:202-462-1957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03195101YM0800X
DCLC3001921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical