Provider Demographics
NPI:1275958969
Name:FLEISCHER JACKSON, SUSAN (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:FLEISCHER JACKSON
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 1:1925 GREENSPRING DR
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4128
Mailing Address - Country:US
Mailing Address - Phone:410-453-9553
Mailing Address - Fax:410-308-8926
Practice Address - Street 1:27 MELLOR AVE
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228
Practice Address - Country:US
Practice Address - Phone:410-922-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-04
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical