Provider Demographics
NPI:1275850703
Name:SUSAN L. JOSEPHSON, INC.
Entity Type:Organization
Organization Name:SUSAN L. JOSEPHSON, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOSEPHSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:985-773-8882
Mailing Address - Street 1:5001 HIGHWAY 190 EAST SERVICE RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-4930
Mailing Address - Country:US
Mailing Address - Phone:985-773-8882
Mailing Address - Fax:
Practice Address - Street 1:5001 HIGHWAY 190 EAST SERVICE RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-4930
Practice Address - Country:US
Practice Address - Phone:985-773-8882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5S905Medicare UPIN