Provider Demographics
NPI:1417051673
Name:PERKINSON, SUSANNAH W (LISW)
Entity Type:Individual
Prefix:MS
First Name:SUSANNAH
Middle Name:W
Last Name:PERKINSON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1683 N HAMETOWN RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333
Mailing Address - Country:US
Mailing Address - Phone:330-666-4541
Mailing Address - Fax:
Practice Address - Street 1:1683 N HAMETOWN RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333
Practice Address - Country:US
Practice Address - Phone:330-666-4541
Practice Address - Fax:330-666-4656
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0000552104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PESWO9551Medicare ID - Type Unspecified