Provider Demographics
NPI:1346519717
Name:GOLAB, SUSAN MARGARET (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MARGARET
Last Name:GOLAB
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12409 SOUTH POTOMAC ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-2233
Mailing Address - Country:US
Mailing Address - Phone:480-961-8852
Mailing Address - Fax:480-961-8852
Practice Address - Street 1:1855 E NORTHERN AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-3963
Practice Address - Country:US
Practice Address - Phone:602-770-1856
Practice Address - Fax:480-961-8852
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-107961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical