Provider Demographics
NPI:1366849135
Name:HARVEY, SUSAN (MS)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:HARVEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7665 PORCELAIN TILE CT
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-3897
Mailing Address - Country:US
Mailing Address - Phone:443-679-8437
Mailing Address - Fax:
Practice Address - Street 1:7665 PORCELAIN TILE CT
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-3897
Practice Address - Country:US
Practice Address - Phone:443-679-8437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-22
Last Update Date:2019-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC8634101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health