Provider Demographics
NPI:1306391388
Name:SUSSMAN, EVE (LICSW,LCSW)
Entity Type:Individual
Prefix:
First Name:EVE
Middle Name:
Last Name:SUSSMAN
Suffix:
Gender:F
Credentials:LICSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4950
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-0150
Mailing Address - Country:US
Mailing Address - Phone:781-810-8013
Mailing Address - Fax:
Practice Address - Street 1:1485 CHAIN BRIDGE RD STE 303
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-4501
Practice Address - Country:US
Practice Address - Phone:781-810-8013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-19
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 104100000X
DCLC2000014031041C0700X
VA09040141261041C0700X
MA2243441041C0700X, 1041C0700X
MA1234501041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker