Provider Demographics
NPI:1417173188
Name:SYVARTH, SUSAN J (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:SYVARTH
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1088 N RIGO RANCH RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-1458
Mailing Address - Country:US
Mailing Address - Phone:201-859-2959
Mailing Address - Fax:201-891-7414
Practice Address - Street 1:1088 N RIGO RANCH RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-1458
Practice Address - Country:US
Practice Address - Phone:201-859-2959
Practice Address - Fax:201-891-7414
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-188391041C0700X
NJ44SC012898001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical