Provider Demographics
NPI:1427209212
Name:MCILVAIN, SUSAN M (MSW, LISW-S)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:MCILVAIN
Suffix:
Gender:F
Credentials:MSW, LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 MARKET ST FL 2
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3317
Mailing Address - Country:US
Mailing Address - Phone:215-746-6701
Mailing Address - Fax:215-756-7350
Practice Address - Street 1:3535 MARKET ST FL 2
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3317
Practice Address - Country:US
Practice Address - Phone:215-746-6701
Practice Address - Fax:215-756-7350
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0220541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical